Job Information
WellSense Program Coordinator, Special Kids Special Care in United States
Program Coordinator, Special Kids Special Care
WellSense Health Plan is a nonprofit health insurance company serving members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded 25 years ago as Boston Medical Center HealthNet Plan, we provide plans and services that work for our members, no matter their circumstances.
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294326)
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Program Coordinator works with relevant stakeholders to support the administration of the Special Kids Special Care program. The individual is responsible for working with the SKSC clinical team and serves as the primary liaison to various key WellSense departments including Member Services, Public Partnerships, Utilization Management, Vendor Management, Enrollment and Contracting to ensure timely coordination of services to the SKSC members from the time of notification of enrollment to disenrollment from the program.
The individual will develop a strong working relationship with the Department of Children and Families (DCF) and MassHealth, and will communicate regularly with these external partners on matters pertaining to member enrollment and disenrollment, monthly clinical review team meetings and sharing of individualized member care plans (ICP) and other key program documents.
The individual will be a champion of the SKSC program internal to WellSense, in terms of problem solving and building awareness, and pride in and commitment to the SKSC program as well as with DCF.
Our Investment in You:
Full-time remote work
Competitive salaries
Excellent benefits
Key Functions/Responsibilities:
Maintain and track new member enrollment notifications
Under the direction of the Manager, assign care managers to newly enrolled members using program assignment rules to include geo access and caseload management
Maintain active master member roster list that is available to all key stakeholders
Track and monitor member reassessment and disenrollment process, documentation and timeline
Ensure ongoing communication of member enrollment status within the SKSC program via timely notification and update to tracking reports
Collaborate with the SKSC clinical team, and the WellSense pharmacy, utilization management, and DME vendor to ensure members receive needed services through proactive monitoring of DME, pharmacy, medical service authorizations
Coordinate and schedule the monthly Clinical Review Team meetings with DCF, EOHHS and the SKSC clinical team
Ensure timely distribution of the SKSC Quarterly ICPs (Individualized Care Plans)
Build and manage open cases in the Care Management System
Serve as the administrator for the SKSC SharePoint site, maintaining accessible documentation to support the SKSC program and ensuring all documents within the site are current and accurate
This includes maintaining accuracy of member rosters, member face sheets, CRT meeting documents, program letters and communication templates, policies, procedures and workflows and educational material
Work with Public Partnerships and Member Services on inquiries from MassHealth, DCF, members, and providers and families to problem solve and provide timely information
Provide administrative support for regular meetings. This includes the development of agendas, taking meeting minutes and circulating follow-ups for weekly clinical team meeting and monthly CRT meetings
Serve as the initial contact for calls and emails into the SKSC program's designated triage line, during normal business hours
Identify opportunities for improvement in administrative workflows and processes Other duties as assigned
Regular and reliable attendance is an essential function of the position
Qualifications:
Education:
- Bachelor’s degree in a Healthcare related field or equivalent combination of education and relevant work experience
Experience:
At least 3 years of office experience, specifically in either a high volume data entry office, customer service call center, or health care office administration department
3 or more years of healthcare experience preferred
Experience with health plan utilization/claims
Prior customer service experience
Computer work experience that required active use of 2 or more software programs
Experience Preferred/Desirable:
Prior health plan experience
Experience with FACETS or clinical care management documentation systems or other electronic medical records, other healthcare databases
Experience working in Sharepoint
Experience working in Teams
Experience with Medicaid population
Experience with pediatric patients
Bilingual skills, fluency in Spanish
Competencies, Skills, and Attributes:
Demonstrated ability to use healthcare clinical systems for documentation purposes; ability to effectively navigate systems
Excellent customer service and diplomacy skills
Effective communication skills (oral and written) with ability to successfully collaborate across various functional departments and external constituents such as medical and other service providers and State agencies
Ability to process a high volume of requests with a 95% or greater accuracy rate
Effective time management skills, with the ability to prioritize tasks and remain organized
Proven process improvement skills
A strong working knowledge of Microsoft Office products, including Excel
Demonstrated ability to successfully organize and manage projects
Detail oriented and high degree of independent judgment
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
Apply now (https://jobs.silkroad.com/BMCHP/Careers/Apply/MultiForm/294326)
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