Job ID 55167
Category: Clinical, Unlicensed
Location: Colorado Springs, CO
Posted: 7/19/2018
Job Description
We are currently seeling a dynamic Member Engagement Specialist to join our office in Colorado Springs, CO. This is an exempt position that provides leadership and coordinates the health and wellness outreach efforts for Health First Colorado's (Colorado's Medicaid Program) Members and supports the Office of Member and Family Affairs.
Position Responsibilities:
  • Mastery of the State of Colorado's Regional Accountable Entity's (RAE) contract for any Member-related issues including Health and Wellness, Population Health, Healthy Communities and Appeal and Grievance procedures.
  • Engage Members in their health and well-being by coordinating with Population Health initiatives and Health Needs Surveys to utilize various tools and website Health and Wellness section.
  • Lead a Regional Member Advisory Committee for the RAE. Responsible for creating agenda, recruiting Members, and developing group norms.
  • Lead a Region's Advocate Forums for the RAE. Prepare agenda items and discussion topics related to complaints and peers. Goal is to identify what is relevant for the advocates and provide any updated information. Attend advocates forum and Corporate Wellness and Recovery team meetings as needed.
  • Provide oversight and guidance on complaint procedures. Assist in complex Member clinical complaints. Utilize research and analytical skills to investigate complaints of a clinical nature. Ensure compliance with HCPF's timeliness guidelines. Handles sensitive member information in accordance within HIPAA guidelines, other State and Federal regulations and Beacon policies.
  • Execute deliverables for a region for the RAE, including, but not limited to: Communication Report, Cultural Competency Self-Assessment, Quarterly Grievance and Appeal Report, and Member Services Report. Create accurate, thoughtful, and professional reports in a timely manner.
  • Develop MOUs and BAAs with Healthy Communities within a Region of the RAE to build partnerships with Family Health Coordinators. The goal of these partnerships is to avoid duplication of services in onboarding Members.
  • Create presentations for Lunch and Learns to promote Members' knowledge of their benefits and how to use and access services. Focus on health and wellness topics and utilize motivational interviewing techniques. Work with Training Administrator to ensure that these trainings are documented. Ensure that all Lunch and Learns are updated to website and promoted.
  • Attend State HCPF meetings as assigned. Represent Beacon and the RAE in a professional and collaborative manner and report back to engagement center any pertinent information that Beacon and/or the RAE needs to implement.
  • Collaborate with the State's Ombudsman for any high needs Members. Utilize clinical skills to help resolve any issues and provide prompt responses to HCPF. Ensure that member's rights are upheld. Provide information about rights and document necessary information.
  • Work with Primary Care Medical Providers (PCMP) practices to educate on Zero Suicide initiatives.
  • Support Director by preparing and participating in EQRO audits for Member related tasks, appeals, and other issues as assigned.
  • Attend community events and presentations as requested. Represent Beacon and/or the RAE in a professional manner and leverage relationships to promote Member health and wellness.
  • Train Members, Care Coordinators, Advocates, Providers and Stakeholders on Members' Rights and Responsibilities, health and wellness topics, cultural competency, health literacy and other topics as assigned.
  • Understand Plain Language and Health Literacy skills and be able to review Member-related material to ensure that it is at a 6th grade reading level and is easy to understand. Review any appeal and/or grievance resolution letter prior to sending letter to Member.
  • Support Director in any appeal and/or State Fair Hearing requests.
  • Evaluate website content on a monthly basis and determine necessary updates based on health need surveys, community participation, and HCPF updates.
  • Other duties as assigned.

Position Qualifications:
  • Education: Bachelor's Degree
  • Licensure: N/A
  • Years and Type of Relevant Work Experience:
    • 3+ years of experience in public speaking, motivational interviewing, teaching/training, professional and accurate writing skills, problem-solving skills, understanding of integrated care, and lived experience.
    • 3+ years of Managed Care preferred
    • Able to advocate for Members and utilize resources to improve Members' health and wellness.

Click below on 'Apply for this Position' to create a profile and apply for the position
Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled


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