Company Description:
Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.
We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.
Position Responsibilities:
Specific
Position Qualifications:
Competencies:
Experience:
Physical Requirements:
Time Zone: Eastern or Central
Other Information:
EEO Statement:
It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.
Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.
We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.
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Position Responsibilities:
Specific
- Complete assigned tasks at the direction of professional staff/team leader/manager
- Maintain timely and effective internal and external communication regarding assigned members/ work/tasks
- Log, track, and ensure completion of all work in compliance with contract service standards
- Manage high workload volumes, ensuring accuracy and compliance with deadlines
- Interview members/ providers to document needs and potential referrals/ interventions
- Facilitate member connection to community resources, as identified
- Conduct Health Risk Screenings
- Scheduling member appointments with Providers
- Scheduling member transportation
- Ensure necessary information is available and organized for professional staff review/ resolution
- Outreach as necessary for clarification or collection of additional information needed
- Prepare documentation and summaries for further review by professional staff
- Access and review available resources to support decisions
- Perform job functions with a high degree of discretion and confidentiality in compliance with federal, company & departmental confidentiality guidelines
- Maintaining timely and effective internal and external communication regarding assigned work/ tasks
- Logging, tracking, and ensuring completion of all work in compliance with contract service standards
- Tracking review completion of assigned work to ensure final closure/ resolution
- Managing high workload volumes, ensuring accuracy and compliance with contractual deadlines
- Ensuring all necessary information is available and organized for professional staff review/resolution
- Outreach as necessary for clarification or collection of additional information needed
- Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, company & departmental confidentiality guidelines
Position Qualifications:
Competencies:
- Previous experience with health plan care management/ coordination operational processes for multiple lines of business (LOBs) including Medicare Advantage, Managed Medicaid, Dual SNP, & Commercial Lines of Business
- Patient advocacy
- Knowledge of community services network and safety net system, including the Foster Care system
- Strong internal/external customer-service, organizational, multitasking, and teamwork skills
- Analytical/ Problem Solving Skills
- Strong communication skills - verbal and written
- Ability to perform critical analysis and facilitate/ promote positive outcomes
- Ability to work effectively in a fast-paced environment with multiple priorities, deadlines, and workloads
- Ability to offer positive customer service to every internal and external customer
- Knowledge of current insurance benefit structures
- Proficiency in Microsoft Office
Experience:
- 2+ years of experience work for a Managed Care (Payer)
Physical Requirements:
- Must be able to sit in a chair for extended periods of time
- Must be able to speak so that you are able to accurately express ideas by means of the spoken word
- Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
- Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
- Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
- Must have be able to fluently communicate both verbally and in writing using the English language
Time Zone: Eastern or Central
Other Information:
- Expected Hours of Work: Monday – Friday 8 am – 5 pm; with ability to adjust to Client schedules as needed
- Travel: May be required, as needed by Client
- Direct Reports: None
- Salary Range: $32,000 – $50,000
EEO Statement:
It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.
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