Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Assists the team with quality checks for enrollment, disenrollment and payment processing to ensure the Field Marketing Organizations, independent agents, Community Partners and other vendors are compliant with all regulatory and CalOptima Health requirements in accordance with the agreement.
Participates in CalOptima Health workgroups to meet its contractual requirements with the Center for Medicare and Medicaid (CMS), California Department of Health Services (DHCS), Department of Managed Health Care (DMHC), and any other applicable entity.
Serves as knowledge expert for assigned functional areas.
Participates in Audit and Oversight Committee meetings as needed.
Serves as the primary health plan support and point person with agent/brokers, other CalOptima Health departments for administrative functions of operating OneCare (HMO D-SNP) Outreach and Education and Provider Relations departments.
Works with department staff to maintain health plan management operations, including staying updated with relevant CMS and Medi-Cal regulations and requirements.
Facilitates review and approval of departmental policies for sales team and agent/brokers.
Coordinates community events in support of member or provider outreach team functions.
Reviews and manages status of enrollment in the OneCare (HMO D-SNP) program and act as a liaison with the Enrollment and Reconciliation department and communicate to assure accurate and timely enrollments.
Acts as liaison between CalOptima Health and the community to effectively resolve issues.
Prepares meeting materials, meeting set-up, minute taking, etc. as designated by the Manager.
Maintains an inventory of marketing, enrollment supplies, including monitoring needs and ordering for supplies, member material and promotional items for the Sales and Marketing department.
Coordinates delivery/shipment of marketing brochures and enrollment/sales kits for the FMO/Broker Agencies.
Oversees the agent support mailbox and dedicated phone number and responds to inquiries or redirects to appropriate staff or department for assistance.
Provides support for specific and/or ongoing projects, such as generating reports, logs, calendars, and mailings, applying general business practices, as well as CalOptima Health policies and procedures under the direction of the Manager and Supervisor.
Maintains confidential and sensitive information and files regarding management projects, policy and personnel ensuring appropriate follow-up.
Completes other projects and duties as assigned.
Requirements :
High School diploma or equivalent required.
2 years of work experience in health care administration with demonstrated or potential competence in working with health plan management functions required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.