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CRC Specialist

Company: CalOptima
Location: Orange
Posted on: June 1, 2021

Job Description:

Department(s): Customer Service Reports to: Supervisor, OneCare Connect Customer Service FLSA status: Non-Exempt Salary Grade: D - $44,000 - $58,000 Job Summary This position will provide telephonic and in person customer service to OneCare Connect Cal MediConnect members, facilitating the direction of each inquiry regarding access to healthcare, community, and other services. OneCare Connect Customer Service, Sr. Representatives monitor follow-through on needed care and follow-up on open issues. Works closely with clinical staff to assist members in resolving healthcare and psychosocial related issues. Maintains outreach efforts that includes 45-day follow-up calls, birthday greeting calls, and other outreach campaigns to nurture open communication and understanding of the program. OneCare Connect Customer Service, Sr. Representative may also perform outreach activities at cultural events/fairs within Orange County, on occasion, in conjunction with the Community Relations department. Position Responsibilities: Guides members in understanding and accessing the benefits they are entitled to under Medicare and Medi-Cal, through the OneCare Connect program. Provides members with information to help them distinguish between Medi-Cal and Medicare benefits/claims processed through the OneCare Connect program. Assists with coordination of member's health care and social service needs both within and outside the Medical Group and CalOptima. Maintains documentation of member cases within the FACETS system. Initiates referrals to both internal and external care management departments and other department/government or community agencies. Participates in special events/fairs outside of regularly scheduled working hours, as needed. Participates in departmental phone outreach campaigns on a regular basis. Other projects and duties as assigned. Knowledge & Abilities: Maintain accurate records and documentation. Develop rapport, establish, and maintain effective interpersonal relationships with internal and external contacts at all levels. Prepare and provide effective orientations and education presentations. Work with Case Management staff to expedite the resolution of member concerns. Remain knowledgeable of the medical groups and OneCare Connect's benefit structure. Speak, understand, read and/or write in a second language in addition to English is required for some assignments. Communicate clearly and concisely, both verbally and in writing with individuals from diverse backgrounds. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Experience & Education: High school degree or equivalent required. 2+ years of experience in a customer/member service or call center capacity required. Bilingual in English and in one of CalOptima's defined threshold language (Spanish, Vietnamese, Arabic, Farsi, Korean, Chinese) is required. Preferred Qualifications: 2+ years Health Maintenance Organization (HMO), Medi-Cal/Medicaid and health services experience preferred. Knowledge of: Medicare and Medi-Cal eligibility and benefits preferred. Issues that face members with special needs, such as seniors and persons with disabilities. Principles and practices of health care service delivery and managed care, Medi-Cal/ CalOptima eligibility and benefits. Principles and techniques to serve the SPD population in diverse social and ethnic groups. EEO Statement: CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. ADA/Accommodation Statement: If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations with 72-hour notice by contacting Human Resources Disability Management at 657-900-1134.

Keywords: CalOptima, Orange , CRC Specialist, Other , Orange, California

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