Director of Member Services

COMMUNITY HEALTH GROUP•Chula Vista, CA

28d

About The Position

Directs and oversees all aspects of an organization's customer service and transportation (rideshare) policies, objectives, and initiatives. Develops and establishes procedures and policies governing customer correspondence and the handling of customer complaints. Serves as senior management and strategic planner for the Customer Service/Member Services Department (CS/MS) and CHG Transportation Department (Rideshare), including staff supervision, fiscal and operational functions. Develops and implements new programs, services and special projects as they relate to Member Services and/or Transportation Services. COMPLIANCE WITH REGULATIONS Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures in compliance with applicable state and federal regulations including DHCS, DMHC, CMS and Medicare Part D.

Requirements

Master’s Degree in Public Health, Business, Health Administration or related field required.
Seven years management experience including direct supervision of a large customer service team within a health care organization (managed care health system experience preferred), which must have included experience with the Medi-Cal program, Member Services and Transportation Services.
Working knowledge of the California Medi-Cal program, of the Cal Medi-Connect CMS DSNP and CSNP programs and of entitlement programs.
Familiarity with the legal requirements relating to privacy and healthcare operations, as well as the ability to communicate effectively with staff.
Ability to plan, assign and supervise the work of others.
Detail oriented with strong analytical abilities.
Ability to communicate effectively, both verbally and in writing.
Ability to establish and maintain effective and cooperative working relationships with all staff and others contacted in the course of the work.
Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.
Ability to think and work effectively under pressure and accurately complete tasks within established times.
Ability to separate friendship from leadership in the workplace.

Nice To Haves

Bilingual (English/Spanish) preferred.

Responsibilities

Serves as senior management and strategic planner for the Customer Service/Member Services and Transportation Department, including personnel, fiscal and operational functions.
Ensures adherence and full compliance with all regulatory requirements/benchmarks.
Successfully passes Member Services and Transportation Services audit reviews by regulators including DHCS, DMHC and CMS with zero or minimal findings.
Develops, implements and monitors policies and procedures designed to support the business operations of the CS/MS and transportation departments including, Member eligibility verification, explanation of benefits, PCP assignment and referral information, and complaint resolution on a 24/7 basis.
Oversees development, implementation and maintenance of departmental policies and procedures.
Designs programs and services, develops work plans and supervises the implementation of programs and services as they relate to Member Services and Transportation Services.
Evaluates the needs of the CS/MS and Transportation Departments and develops and adjusts strategies and goals accordingly.
Evaluates existing systems, programs and designs, and implements modifications as needed.
Conducts and/or directs orientation and training of community agencies regarding CHG’s member services and transportation services as needed.
Develops and maintains departmental policies and procedures to meet organization’s goals and to ensure regulatory/contractual compliance.
Responsible for establishing, implementing, monitoring and reporting on performance standards for Customer Service/Member Services, e.g. telephone activities, member contacts, complaint resolution turn-around time, etc. and Transportation Services.
Oversee the development of a Quality Monitoring program to evaluate staff and department performance.
Oversee the recruitment, training, and monitoring of Customer Service/Member Services and Transportation Services staff; develops and implements training programs to improve performance, efficiency and effectiveness to ensure member and provider satisfaction.
Responds to and coordinates external audits to assure that appropriate actions are taken to resolve any problems.
Researches, proposes and implements policy changes responsive to the changes in lines of business and/or business needs, and reviews proposed policies and implementation plans for value and appropriateness.
Oversees the development of processes to support new programs, membership or benefits.
Work collaboratively with designated departments and delegated partners to develop and maintain workflows to support business.
In collaboration with the Marketing Department, participate in activities developed to promote Plan recognition and enrollment.
Designs and implements programs for improving customer/member satisfaction.
Ensures all vehicles used by CHG Rideshare drivers pass routine safety inspections prior to hire.
Ensures all Rideshare drivers are fully trained on customer service and including door-to-door assistance for members when picking them up.