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Senior Lead Member Support Specialist (Medicaid)

Job Title
Senior Lead Member Support Specialist (Medicaid)
Job ID
Colorado Springs,  CO 80920
Other Location

Position Summary:  The Senior Lead Member Support Specialist will be responsible for the following: a) subject matter expert for Member Support Specialist and Senior Member Support programs; b) conducting monthly and as needed call monitoring; c) conducting telephonic and in-person or field-based care coordination and system navigation for members with physical and behavioral health needs; d) liaising between members and their primary care providers and/or behavioral health providers for streamlined care coordination, appointment scheduling, follow up, and member advocacy; e) initiating and completing care plans for physical and behavioral health, member identified goals and communicating care plan progress to primary care providers and behavioral health providers; f) managing inbound and outbound call volume through real-time queue and IVR monitoring; and g) monthly and as needed reporting duties as assigned.   


COMPETENCIES/Role-Specific Functions: 


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 Specialist and Senior Member Support Specialist programs to assure best practices in outreach and member communication
  • Provides feedback on team and makes recommendations to Member Support Services supervisor  
  • Participates in meetings and presents information as needed
  • Functions as a liaison between Medicaid members, health systems, physical and behavioral health providers and CCHA Member Support Services
  • Effectively communicates both verbally and written with members, providers, and other healthcare professionals.



Breaks down problems into smaller components, understands underlying barriers, can simplify and process complex issues, understands the difference between critical details and unimportant facts.

  • Assists the Member Support Specialist team with accurately coordinating care coordination referrals, including: a) assessing for level of urgency; and b) assessing for risk, including identifying physical and behavioral health needs, and c) reviewing, documenting, and determining appropriate level of care coordination.
  • Seeks appropriate intervention in a timely manner to assure problem prevention and resolution. 
  • Identifies, develops, and utilizes community resources appropriately.



Establishes project goals, milestones, and procedures, defines roles and responsibilities, acquires project resources, coordinates projects throughout company, monitors project progress, manages multiple projects.

  • Tracks and reports results of outreach projects
  • Monitor and distributes voicemails to assist with daily workflow
  • Monitors inbound call volume to assist with service level standards   
  • Monthly reporting duties as assigned



Acting as subject matter expert for the team and the ‘go to’ person for questions and answers.  Delivering formal and informal training on day to day objectives within the team.

  • Provides feedback on team performance to supervisor and assists in development of action plans
  • Coordinates new-staff orientation with supervisor and assists in training
  • Assists in on-going education of program changes to Member Support Specialist and Senior Member Support Specialist teams



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.

  • Has working knowledge of local community programs, government, and social agencies conveys that knowledge to team members when appropriate
  • Single point of contact for delegated care coordination referrals
  • Develops strong telephonic relationships with members to include handling escalated Medicaid members as well as complaints and grievances



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.

  • Maintains caseload across Member Support Services and Senior Member Support Services programs
  • Handles inbound and outbound calls to assist with service delivery
  • Subject matter expert on CCHA programs, goals and initiatives
  • Maintains confidentiality and ensures compliance with HIPAA regulations.
  • Other duties as assigned.


Qualifications (Education/Experience/Knowledge/Skills/Abilities): 

  • High school diploma or GED required. 
  • Bachelor’s degree, and/or experience in a Social work, or Behavioral Health related field, Licensed Practical Nurse, or certified Medical Assistant preferred. 
  • One to two years in a healthcare setting.  Three years preferred.
  • One to two years of customer service experience.  Three years preferred.
  • Advanced computer skills utilizing Microsoft Excel, Word and Outlook.
  • Possess excellent customer service skills and ability to effectively interact with PHP personnel, medical and facility staff, other healthcare professionals and the general public.
  • Precise and detail oriented in managing, editing and communicating information through spreadsheets and computer systems.
  • Ability to work effectively and communicate with other teams and personnel within the PHP organization.
  • Skilled in conflict management, problem prevention and resolution.
  • Knowledge of medical terminology
  • Able to accept and work with diverse populations and provide culturally sensitive education and assistance to patients/families.
  • Available to begin workday as early as 8 am.
  • A valid unrestricted Colorado drivers’ license.  
  • Reliable and insured vehicle.

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