Qureos Mentor

Inland Empire Health Plan

<div>Overview:
<div><b>
What you can expect!</b></div><div><br>
</div><div>Find joy in serving others with IEHP! We welcome you to join us in &ldquo;healing and inspiring the human spirit&rdquo; and to pivot from a &ldquo;job&rdquo; opportunity to an <b>authentic experience!</b></div><div></div><div><br>
Medicare Member Services Representative is responsible for being a devoted and compassionate advocate for Medi-Cal, Medi-Medi and Medicare Members when assisting with maximizing their benefits, navigating the healthcare system and reaching their optimal health. Using multiple complex systems, responsible for providing guidance and answering questions from Members about their benefits and medical claims, as well as educating Members about wellness programs. Assisting Members in assessing tools available to help guide decision-making about complex matters related to their wellbeing. Facilitate the Members selection and access to in-network healthcare providers. Collaborate with inter-departments to ensure Member needs are met.</div><div></div><div><br>
Commitment to Quality: The IEHP Team is committed to incorporate IEHP&rsquo;s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.</div><div></div><div><b><br>
This is a short-term role with a duration of up to 6 months. Please note that this position is not eligible for benefits.</b></div><div></div><div><b><br>
While there is a possibility that this role could lead to a permanent position, permanent employment is not guaranteed and will depend on business needs, performance, and other factors.</b></div>
Additional Benefits:<div></div><div><div><br>
Hourly rate: $23.00/HR</div></div>
Key Responsibilities:
<ul><li>Handle Medi-Cal and Medicare Inbound Calls<ul><li>
Responsible for covering the Cisco ACD Queue telephone lines.</li><li>
Meet IEHP and Member Services Call Center standard and policy requirements.</li><li>
Assist Members with many different process or benefit information such as:<ul><li>
Members eligibility status</li><li>
Primary care/facility assignments, selections and changes</li><li>
Health program education</li></ul></li><li>
Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards</li><li>
Maintain knowledge of other department&rsquo;s roles as they pertain to Member Services standard work processes, to ensure proper handling of calls</li><li>
Ensure key performance indicator goals are met monthly (Quality Assurance, AHT, Adherence).</li><li>
Bilingual Position: Coordinate telephonic translation of calls when Members do not speak English or Spanish</li></ul></li><li>
Off phone work<ul><li>
QA Review</li><li>
One on One</li><li>
Projects</li><li>
Meetings</li></ul></li><li>
Any other duties as required to ensure Health Plan operations are successful</li><li>
Ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP's policies and procedures relating to HIPAA compliance</li></ul>
Qualifications:
<p><b>
Education &amp; Requirements
</b></p><ul><li>Experience Requirements:<ul><li>
Two (2) years of HMO or Manage Care customer service experience analyzing and solving customer problems</li></ul></li><li>
High school diploma or GED required</li></ul><div></div><div><b><br>
This is a non-bilingual: bilingual highly preferred position. Identified bilingual team members in this role must take a language proficiency assessment and must receive a passing score.</b></div><p></p><p><b><br>
Key Qualifications</b></p><ul><li>
Knowledge of Medicare managed care is preferred</li><li>
Knowledge of Medical terminology, and Medi-Cal managed care is required</li><li>
Understanding of and sensitivity to multi-cultural community</li><li>
Proficiency in Microsoft Office Suite; high level capacity to multitask</li><li>
Excellent multi-tasking skills. Typing 35 words per minute, proficient in Windows applications, and experience in data entry</li><li>
Knowledgeable of with the following programs: Cisco Finesse, Verint, HSP, Microsoft</li><li>
Excellent written and verbal communication and interpersonal skills</li><li>
Strong organizational skills</li><li>
Ability and willingness to learn and follow direction in a fast-paced call center environment</li><li>
Ability and desire to handle 25-30 calls per day</li><li>
Adherence to specific work schedule is required</li><li>
Works well in a fast-paced environment</li><li>
Team culture a must</li><li>
Positive Attitude and ability to work in a team setting</li><li>
High level of patience</li><li>
Telephone courtesy</li><li>
Attention to detail</li><li>
Willingness and ability to learn</li><li>
Ability to work independently within specified time constraints</li><li>
Excellent punctuality and attendance required</li><li>
Ability to adapt and perform duties efficiently when unexpected changes arise</li><li>
This position will work non-traditional hours to achieve coverage during periods where training or extended call center operations are required</li><li>
Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval</li><li>
All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP&rsquo;s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership</li></ul><p></p><p><b><br>
Start your journey towards a thriving future with IEHP and apply </b><b>TODAY</b><b>!</b></p>
Work Model Location:
<p>
Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP&rsquo;s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership)</p>
Pay Range: USD $23.00 - USD $23.00 /Hr.</div>

Member Services Representatives - Medicare (Short Term Assignment)

<div>Overview:
<p><b>
What you can expect!</b></p><p><br>
</p><p>Find joy in serving others with IEHP! We welcome you to join us in &ldquo;healing and inspiring the human spirit&rdquo; and to pivot from a &ldquo;job&rdquo; opportunity to an <b>authentic experience!</b></p><p></p><p><br>
Under the Policy &amp; Regulatory Operations Manager&rsquo;s general supervision, the Analyst II &ndash; Policy &amp; Regulatory Operations helps ensure Health Services, Quality Systems, Provider Services, and Member Services remain in compliance with Local, State, Federal, contractual and accreditation requirements and supports these departments&rsquo; operational strategies by completing compliance assessments, regulatory reviews and audit&#8208;related submissions; managing cross&#8208;functional regulatory implementation, operational and system enhancement projects.</p><p></p><p><br>
The Analyst II - Policy &amp; Regulatory Operations is responsible for Local, State, Federal, contractual and accreditation requirements interpretation, gap analysis, project scope develop and initiation, resource planning, risk identification and project implementation, as well as timely comprehensive review and maintenance of internal and Provider policies. for the purpose of gap analysis, project scope development and initiation, resource planning, risk identification, and project implementation, as well as timely and comprehensive review of internal and Provider policies. To do these effectively, the Analyst II &ndash; Policy &amp; Regulatory Operations must have a clear understanding of IEHP business operations and the responsibilities of various departments in Health Services, Quality Systems, Provider Services, and Member Services, and demonstrated ability to effectively and consistently manage multiple projects and priorities concurrently.</p><p></p><p><br>
Commitment to Quality: The IEHP Team is committed to incorporate IEHP&rsquo;s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.</p>
Additional Benefits:
<p><b>
Perks</b></p><p></p><p><br>
IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.</p><ul><li>
Competitive salary</li><li>
Hybrid schedule</li><li>
State of the art fitness center on-site</li><li>
Medical Insurance with Dental and Vision</li><li>
Life, short-term, and long-term disability options</li><li>
Career advancement opportunities and professional development</li><li>
Wellness programs that promote a healthy work-life balance</li><li>
Flexible Spending Account &ndash; Health Care/Childcare</li><li>
CalPERS retirement</li><li>
457(b) option with a contribution match</li><li>
Paid life insurance for employees</li><li>
Pet care insurance</li></ul>
Key Responsibilities:
<ul><li>Responsible for planning and managing cross&#8208;functional projects, which may include, but not be limited to projects that support regulatory compliance, system enhancement, process development, and improvement within a single or multiple departments in Health Services, Quality Systems, Provider Services, and Member Services. This responsibility includes: developing and defining the project scope, goals, and deliverables; developing, monitoring, and maintaining a detailed project plan; managing changes to the scope, schedule, and deliverables; communicating potential risks; ensuring successful relationships between project stakeholders and resources to ensure timely delivery of project outcomes; reporting and escalating project status and barriers to management, as needed; and creating and maintaining comprehensive project documentation.</li><li>
In collaboration with department policy owners, review, update and manage internal and Provider policies for their assigned department(s) to ensure that these are kept current, accurate and in accordance with applicable regulatory and accreditation requirements. This responsibility includes supporting the management and publication of IEHP Provider Manual of Policies and Procedures, electronic Data Interchange (EDI) Manual and internal department manuals; researching, reviewing and citing regulatory and accreditation requirements, plan policies, and other relevant sources; identifying compliance and/or operational risks as well as upstream and downstream impacts of policy changes on other department(s) and/or documents; and defining and summarizing the degree and description of change.</li><li>
Facilitate the timely and comprehensive assessment or examination of current policies and standard procedures against new regulations for the purpose of identifying the health plan&rsquo;s state of compliance, regulatory and process gaps, and action plan.</li><li>
Responsible for identifying, gathering, developing, and bookmarking evidence and/or narratives for regulatory and/or audit&#8208;related submissions.</li><li>
Facilitate cross&#8208;functional implementation projects that support compliance with Local, State, Federal, contractual and accreditation requirements. This responsibility includes requirements interpretation, gap analysis, project scope development and initiation, resource planning, risk identification, implementation, and ensuring the development and implementation of compliance monitoring at the department level.</li><li>
At the direction of the Policy and Regulatory Operations Manager, support departments in the completion of their system enhancement and/or process development requests by facilitating the development and documentation of process flow, standard work, and business requirements, as well as testing and validating system enhancements prior to implementation.
</li><li>Serve as the primary analyst reviewer and support for their assigned department(s). This responsibility includes preparing draft work output for quality assurance review by the Policy and Regulatory Operations Manager or Analyst III.</li><li>
Perform a broad range of project management and research activities, using analytical and critical thinking skills.</li><li>
Support departments in Health Services, Quality Systems, Provider Services, and Member Services to make Lean business decisions by identifying and communicating identified opportunities for process improvements.</li></ul>
Qualifications:
<div><b>
Education &amp; Requirements
</b></div><ul><li>At least three (3) years of experience providing analytical and/or project implementation support, including but not limited to regulatory review and analysis in a healthcare setting</li><li>
Bachelor&rsquo;s degree from an accredited institution required</li></ul><div><b>
Key Qualifications</b></div><ul><li>
Must have a valid California Driver&rsquo;s license</li><li>
Working knowledge of project management software such as Workfront, MS Project or equivalent</li><li>
Knowledge of managed care industry practices and standards including Local, Federal, State and/or accreditation standards, is preferred</li><li>
Must have strong organizational skills</li><li>
Must have strong critical thinking, research, verbal, and written communication skills</li><li>
Demonstrated proficiency in Microsoft Office products: Word, Excel, Visio, and Power Point, sufficient for use in all aspects of an office environment</li><li>
Must have the ability to manage multiple projects with competing deadlines and changing priorities</li><li>
Must have the ability to work well in a team environment and build effective relationships with Team Members at all levels</li><li>
Must be detail oriented</li><li>
Exceptional follow&#8208;through to track all outstanding tasks and ensure these are completed timely</li><li>
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and lift or move up to 25 pounds</li><li>
Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus</li></ul><div></div><div><b><br>
Start your journey towards a thriving future with IEHP and apply </b><b>TODAY</b><b>!</b></div>
Work Model Location:
<div>
This position is on a hybrid work schedule. (Mon &amp; Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)</div>
Pay Range: USD $80,059.20 - USD $106,059.20 /Yr.</div>

Analyst II - Policy & Regulatory Operations

Join Inland Empire Health Plan and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Inland Empire Health Plan

ABOUT_COMPANY

Member Services Representatives - Medicare (Short Term Assignment)

Analyst II - Policy & Regulatory Operations