Job Title: Risk Adjustment Care Navigator 

Program: Clinical Risk Adjustment

Department: Health Management Services 

Direct Report: Clinical Risk Adjustment Program Manager

Location: On Site 

Position Type: Full Time or Part Time

Job Description: The Clinical Risk Adjustment Program Member Engagement Representative engages health plan members and schedules Risk Adjustment appointments.

ROLE AND RESPONSIBILITIES

• Engage health plan members and employ professional techniques during verbal communications, electronic correspondence, and text-based interactions with each member.
• Assist health plan Members with scheduling appointments with the Nurse Practitioners (NP’s).
• Update and maintain accurate documentation of each member’s encounter in the electronic health record (EHR).
• Accurately document appointments.
• Properly execute member referrals/concerns/grievances when applicable.
• Document timely member observations requiring administrative notification of any critical member issues/concerns.
• Interact with staff and members to optimize workflow efficiency.
• Compliant with Performance Goals / Contract Deliverables.
• Help promote a company culture that encourages top performance and high morale.
• Follow all Policies and Procedures of SCCP.
• Participate in all SCCP mandatory and CMS regulatory training.
• Attend all staff meetings – in person or via telephone (if unable to attend, responsible for knowledge of content).
• Develop a comprehensive understanding of SCCP information security policies.
• Abide by all SCCP information security policies, procedures, protocols, and practices.
• Abide by principles and laws related to confidentiality.
• Report information security risks when they are identified.
• Participate in regular information security management trainings.
• Develop a comprehensive understanding of SCCP information security policies.
• Abide by principles and laws related to confidentiality.
• Demonstrate respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).
• Engage in continuing education and training for professional growth and development.
• Other duties as assigned by Direct Report.

QUALIFICATIONS AND EDUCATION REQUIREMENTS

• High School Diploma or Equivalent Required.
• Minimum of 1 year of Call Center Representative Experience Preferred.
• Minimum of 2 years in a Customer Service Role Required.

PREFERRED SKILLS

• Excellent verbal communication skills.
• Ability to interact with health care professionals in a professional manner.
• Computer Literate – Word, Google Doc and Excel.
• Able to multi-task, manage time and set priorities.
• Able to remain coachable and teachable at all times.