Job Description
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.
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Job Summary
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Contacts members, educating them about wellness initiatives that align with the Value Based Purchasing initiatives, HEDIS standards, and EPSDT goals. Assists with coordinating contact and following through with member's Primary Care Physician. Meets the neutral standards established by the regulatory body of the jurisdiction but strives for the VBP incentive range and / or EPSDT goals. If there are no VBP targets, meets the 75th percentile for HEDIS, but strives for the 90th percentile for HEDIS. Fulfills the outreach contractual criteria required by the regulatory body of the jurisdiction and assists MedStar Family Choice providers with outreach to members including those members who have been non-compliant or who are difficult to reach. Play a key role in connecting members with health care providers and specialist.
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Minimum Qualifications
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Education/Training
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High school graduation or equivalent. Associate's degree or related certification preferred.
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Experience
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6 months customer service experience in a managed care or social service setting; Medicaid experience preferred.
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License/Certification/Registration
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Medical Assistant certification or equivalent preferred.
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Knowledge, Skills & Abilities
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Typing and filing skills. Demonstrates proficiency with Microsoft Word, Excel, and PowerPoint applications. Strong interpersonal and written communication skills. Effective communication, customer service and presentation skills. Detailed-oriented with the ability to manage multiple task. Periodically assess practices and outcomes to determine efficacy. Time management skills to prioritize and meet mandatory deadlines. Flexibility to work in a changing environment. Excellent organizational and leadership abilities. Ability to identify barriers for analysis, decision making and process improvement.
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Primary Duties and Responsibilities
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Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
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Accurately documents all member appointments and outreach efforts, successful and unsuccessful, in the computer system per MFC policy/audit tool. Based on the assigned Wellness-Preventative Care Program may be responsible for obtaining a copy of the completed services to track compliance and overall utilization score.
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Assists the Quality Improvement Department with the collections of clinical records utilizing MedConnect, CRISP, lab database, etc. during the annual HEDIS audits.
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Attends required meetings and participates on committees as requested.
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Demonstrates behavior consistent with MedStar Health mission, vision, goals, objectives and patient care philosophy.
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Initiates, coordinates, attends and/or presents at wellness community events or venues to educate the community and providers about the services provided by MFC.
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Adheres to best practices and empowerment-based approaches to collaboratively coordinate care for assigned households. Assists with the development and implementation of member incentive programs to encourage compliance with wellness and preventative care. Assists with special mailings and program drawings, and gift card mailings, when indicated, for assigned Wellness and Preventative Care Program.
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Sends text message and / or email reminders for appointments and outreach messages to encourage adherence to wellness and preventative care.
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Contacts all head of households (HOH) in territory at least once by the end of the first quarter of the calendar year.
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Facilitates member understanding and utilization of the MFC Benefit Plan, resolves member inquiries, and assists the patient in coordinating care or services when requested or required.
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For assigned territory, develops and implements strategies to engage members with the annual wellness requirements as established by the regulatory body in the defined jurisdiction and NCQA (HEDIS). Coordinates appointments as necessary; educates members about the importance of preventative care; and, facilitates and supports the member’s relationship with their PCP.
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Works with providers in assigned territory to schedule doctor days. Schedules and successfully implements at least three doctor days per year. Works with PCP to perform member calls from the provider office as needed.
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Generates case management referrals and quality referrals as needed.
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Maintains the "macro reporting" database which refreshes monthly enabling proactive statistics on compliant members for the assigned territory / program and an active list of members to call and coordinate preventive care appointments.
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Performs other duties as assigned.
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Processes transportation requests for members when criteria are met. Accurately documents transportation services per MFC policy.
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Processes Welcome-Orientation calls when contacted by a new MedStar Family Choice Member and documents in the computer system.
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Provides ACD telephone coverage and processes calls related to PCP and provider questions, eligibility and benefits, transportation, and authorization issues when assigned.
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Utilizes a multitude of systems to locate members and coordinate care. Enters corrected contact information in the Clinical Software System Completes Local Health Department referrals or referrals to local jurisdiction as per their process, and documents follow up results from this agency.
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Maintains productivity standards for call volumes per day and appointment scheduling as set forth by management.
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MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.