Responsible for providing initial contact between distinct Care Management/Quality programs and specific identified members.
Under direct supervision handles inbound/outbound enrollment and engagement calls via the WDE dialer system with eligible members to provide information regarding program features.
Primary duties may include, but are not limited to: Gathers and records appropriate member information in accordance with policies and procedures via telephone.
Encourages members to participate in the Care Management/Quality programs by providing information about the program, outlining program features/value and explaining available services.
Records call details and utilize call scripts as needed based on client requirements. Directs member inquiries to appropriate clinical staff.
Initiates referrals and manages consults from clinicians for participants registered in Care Management/Quality.
Gathers information from hospitals, health plans, physicians, patients, vendors and other referral sources.
Contacts physician offices to obtain demographic information or related data as needed.
Education and Experience:
Requires a HS diploma or the equivalent and a minimum of 6 months of experience in a telesales or customer service; or any combination of education and experience which would provide an equivalent background.