Full-Time Community Services Representative
Job Description
Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year.
We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.
We are currently recruiting for:
TITLE: Community Services Representative
Target Hiring Range: $34,800.00 Plus Commission
EEO1: Sales Workers
POSITION SUMMARY
Addresses and resolves provider issues and ensures providers are kept up to date on policies/procedures and any contractual changes. Coordinates provider education and training. Provides information and education on Medi-Cal managed care and Community Health Group (CHG) to Medi-Cal beneficiaries, community based organizations and the general public. Cultivates and sustains positive working relationships with providers and with community organizations serving potential members. Enrolls Medi-Cal beneficiaries interested in joining CHG.
COMPLIANCE WITH REGULATIONS
Works closely with all necessary departments to ensure that utilization management processes, programs and services are accomplished in a timely and efficient manner. Works in accordance with CHG policies and procedures, and in compliance with applicable state and federal regulations, including CMS, DMHC and DHCS.
RESPONSIBILITIES
- Enhances the visibility of the organization by making individual and group presentations, and outreach to providers, provider staff and staff of community organizations.
- Establishes and maintains positive relationships and open lines of communication with providers to ensure concerns are addressed on a timely basis by visiting assigned provider sites on, at a minimum, a weekly basis.
- Addresses and resolves provider issues related to day-to-day operations.
- Provides and interprets information, updates, and alerts to ensure providers are effectively informed on various procedures/issues related to Claims, Customer Service, HEDIS and others.
- Works with Claims, Customer Service, Contracting and other departments to ensure provider issues related to contract terms and rates are resolved and administered correctly.
- Implements plan policies and procedures and provides input on revisions to policies related to providers.
- Promotes CHG’s Medi-Cal health plan by organizing and participating in community health fairs and other events.
- Enrolls Medi-Cal beneficiaries interested in joining CHG.
- Supports team effort by performing other duties as assigned or requested; participating in meetings and on committees; attending work shops, training and seminars; continues professional development; networking; following corporate, division, personnel and safety policies and procedures.
- Maintains product and company reputation and contributes to the team effort by conveying professional image at all times.
- Conduct provider surveys over the phone or onsite.
- Conduct Health Risk Assessment calls as needed.
How to Apply
EDUCATION- Bachelor’s degree preferred.
- Current CA driver's license, proof of auto insurance and working car.
- One year successful sales experience.
- Two year successful community outreach experience, preferably related to Medi-Cal and/or Medicare.
- Knowledge of Medi-Cal managed care plan eligibility requirements and Community Health Group programs and services.
- Familiarity with community social service organizations and groups.
- Bilingual ability in Spanish or Vietnamese required.
- Self-directed; ability to recognize and capitalize upon opportunities to promote CHG programs and services in many different venues.
- Knowledge of Microsoft programs (Word, Excel, Access, etc.)
- Excellent written, verbal and telephone skills.
- Ability to analyze program requirements and regulations, understand contract language and educate providers on related issues.
- Able to manage multiple tasks simultaneously.
- Ability to identify issues and resolve complex problems with internal and external customers.
- Conducting successful sales presentations.
- Making individual and group presentations.
- Ability to prepare materials and train staff.
- Frequent driving
- Public speaking.
- Will be required to work evenings and/or weekends and to carry needed equipment for community events, in personal car (e.g., canopy, helium tank(s), materials, etc.).
- Lifting and carrying up to 30 lbs.
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