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Supervisor, Member Support Services (Medicaid)

Job Title
Supervisor, Member Support Services (Medicaid)
Job ID
27179136
Location
Colorado Springs,  CO 80920
Other Location
Description

Position Summary:  Supports the goals of Colorado Community Health Alliance (CCHA) initiatives and Accountable Care Collaborative (ACC).  The supervisor is responsible for oversight of the Member Support Services Department, including identifying “best practice” procedures, distributing roles and responsibilities according to departmental needs, and assisting in maintaining a balanced flow of work, inbound/outbound call volume, special projects, and program development.  The supervisor will also assist CCHA leadership with assessment, evaluation and recommended changes for department programs. 

 

COMPETENCIES/Role-Specific Functions: 

COMMUNICATION

Communicates well both verbally and in writing, creates accurate and punctual reports, delivers presentations, shares information and ideas with others, has good listening skills.

  • Promotes team communication and acts as the subject matter expert for Member Support Services to ensure best practice in inbound and outbound call assignments and member engagement within the community
  • Responsible for daily, weekly, monthly and PRN reporting to include analysis and recommendations of programs and staffing-model changes
  • Maintains effective communication with manager, internal customer groups, staff, and community partners
  • Presents information at Member Support Services department meetings and represents Member Support Services at larger CCHA meetings

 

DECISION MAKING/JUDGEMENT

Recognizes problems and responds, systematically gathers information, sorts through complex issues, seeks input from others, addresses root cause of issues, makes timely decisions, can make difficult decisions, uses consensus when possible, communicates decisions to others.

  • Distributes and manages case workloads and specialized projects
  • Demonstrates best practice documentation standards, call standards, and member engagement guidelines and ensures adherence
  • Provides feedback on current programs to include suggestions for process change
  • Assists with development and implementation of new initiatives
  • Coordinates with manager and staff on process improvement activities

 

TEAM LEADERSHIP  

Anticipates and resolves conflicts, turns team diversity into an advantage, uses unique team talents, defines processes and goals, works for consensus.

  • Responsible for hiring and training staff, to include coordination of new employee orientation and on-going education of program changes
  • Demonstrates ability to lead and advance team member cohesion and participation
  • Collaborates with CCHA leadership to understand and impove employee satisfaction

 

PEOPLE DEVELOPMENT

Provides feedback and coaching, rewards hard work and risk taking, takes mentoring role, challenges and develops employees, accepts mistakes, provides visibility/opportunity.

  • Performs daily coaching and mentoring and acts as single point of contact for assigned staff
  • Provides feedback on team performance to manager and assists in development of action plans
  • Performs auditing of team case assignments and monitoring of calls to include providing coaching on communication, delivery, and best practice
  • Provides coaching to  team members regarding assessment, intervention, resource development and utilization, data entry, performance and goals
  • Responsible for assessing training needs of staff.  Plans and implements appropriate interventions to educate staff.
  • Conducts one-to-one meetings with staff to review performance and provides feedback as appropriate

 

CUSTOMER FOCUS

Builds customer confidence, is committed to increasing customer satisfaction, sets achievable customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met, solicits opinions and ideas from customers, responds to customers.

  • Develops strong telephonic and relationships with members, providers, and community agencies
  • Handles and resolves escalated member concerns, including complaints and grievances

 

JOB KNOWLEDGE

Understands duties and responsibilities, has necessary job knowledge, has necessary technical skills, understands company mission/values, keeps job knowledge current, is in command of critical issues.

  • Coordinates programs to include being subject matter expert on Member Support Services programs, and inner-departmental goals and intiatives
  • Maintains confidentiality and ensures compliance with HIPAA regulations
  • Monitors caseloads, call volume, and data entry
  • Participates in internal CCHA workgroups
  • Maintains a caseload of complex members
  • Other duties as assigned

 

Qualifications (Education/Experience/Knowledge/Skills): 

  • BA or BS degree in human services or health-related field preferred.
  • Three to five years in a supervisory role.
  • Three to five years experience in a call center setting.
  • Previous experience with Medicaid required.
  • Knowledge of case management or care coordination, community resources and agencies, Medicaid and other social service related programs and processes, program and workflow development, process improvement and implementation.
  • Excellent verbal and written communication skills and the ability convey information clearly to both internal staff and external members/partners to include staff education and coordination and facilitation of meetings/events.
  • Skilled in conflict management to assure problems prevention and resolution.
  • Skilled in time management, ability to complete tasks on time, and ability to multitask.
  • Intermediate level of competence with various computer software applications, including MS Outlook, Word, Excel and PowerPoint.
  • Excellent critical thinking skills.
  • Ability to assess performance of self and others to make improvement or take corrective action
  • Ability to solve resource issues in a creative and positive manner to promote a positive and effective process.
  • Ability to work as a team player with excellent coaching, team building, and problem solving skills to include the ability to make decisions independently.
  • Skilled in exercising a high degree of initiative to achieve organizational objectives.
  • Skilled in customer service to include relating to people inside and outside the organization, building rapport, using diplomacy and tact, and diffusing high tension situations appropriately.
  • Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.

 

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.  The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl.  The employee is occasionally required to climb or balance. The employee must regularly lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision and ability to adjust focus.

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  The noise level in the work environment is usually moderate.