Job Description

Location:

Work from home (Pennsylvania)

Shift:

Days (United States of America)

Scheduled Weekly Hours:

40

Worker Type:

Regular

Exemption Status:

NoEnhanced Member Supports Unit

As this role is listed as Work From Home - it's preferred that you live in the state of Pennsylvania.

In this role, you will assist in resolving patient/member concerns, providing appropriate education/instruction and maintaining patient/member satisfaction by providing the highest level of clinical support. Assists and educates patients/members about available services through motivational interviewing, problem solving, interpreting complex clinical problems, researching information, contacting providers and providing patient/member information. Assists patient/members with social determinants of health, special needs, and/or crisis situations by helping to identify the problem(s) through interviewing skills, identifying primary and secondary resources, by discussing options with the patient/member, and helping them decide on the plan of action. Advocates for patient/member who are incapacitated by age, physical or mental illness or handicap, or who are otherwise unable to communicate with various service delivery systems effectively.

Job Duties:

• Serves as the primary contact for Enhanced Member Supports Unit, Behavioral Health and network for patients/members/providers.
• Assesses all clinical issues and concerns to assure accurate information is provided promptly to patient/member/provider.
• Manages crisis situations with patients/members and triages appropriately.
• Provides assistance with concerns related to social determinants of health.
• Completes resolution for all patient/member/provider concerns and inquiries.
• Provides daily support and direction to patient/member/provider services staff.
• Obtains data on callers’ needs for use in monthly statistical and activity reports.
• Communicates and coordinates with the appropriate internal department to resolve issues.
• Collects and records data on special needs organizations, facilities and services.
• Prepares, generates and appropriately disseminates letter communications to patients and members.
• Provides training within the team as needed.
• Explores covered benefits and community resources as applicable by line of business and product design.
• Provides team building resources to help direct peers to appropriate policies and procedures to assist patients/members/providers.
• Completes outbound calls to patients/members/providers to resolve complex eligibility issues.
• Navigates multiple computer programs while assisting patient/member/provider.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details:

Hours: 8:30am-5pm

As this role is listed as Work From Home - it's preferred that you live in the state of Pennsylvania.

Requirements:

- Bachelor's Degree in a related field of study (Social Work, Healthcare Administration, Psychology, Public Health, Human Services, or a related healthcare/behavioral health field)

- Minimum of 1 year of related work experience

• Full benefits (health, dental and vision) starting on day one

• Three medical plan choices, including an expanded network for out-of-area employees and dependents

• Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA) with employer contribution

• Company-paid life insurance, short-term disability, and long-term disability coverage

• 401(k) plan that includes automatic Geisinger contributions

• Generous paid time off (PTO) plan that allows you to accrue time quickly

• Up to $5,000 in tuition reimbursement per calendar year

• MyHealthRewards wellness program to improve your health while earning a financial incentive

• Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free Care.com membership with discounted backup care for your loved ones

• Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet care; Access free legal guidance, mental health visits, work-life support, digital self-help tools and more

• Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and legal insurance

Education:

Bachelor's Degree-Related Field of Study (Required)

Experience:

Minimum of 1 year-Related work experience (Required)

Certification(s) and License(s):

Skills:

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.

• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.