Remote - Onboarding Specialist

Commonwealth Care Alliance® (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care®, which yields improved quality outcomes and lower costs of care.

Job Summary:

The Onboarding Specialist is the primary contact for members as they transition to a CCA/CareSource health plan. The Specialist contacts new members via telephonic outreach and identifies both the member's existing healthcare services that will continue and new service requests. The Specialist works to ensure that member needs are addressed through liaising with internal CCA/CareSource providers and external healthcare providers. The Specialist also educates the member on health plan offerings and addresses members' questions or concerns.

Essential Functions:

• Serves as the primary member contact and advocate until their care team is established, both through direct member outreach and inbound call support
• Leverages internal and external resources (such as claims, referrals, and pharmacy data) to identify accurate, successful contact information for unreachable or hard-to-reach members
• Orients new members to the value of CCA/CareSource as their health plan, providing education, answering members’ questions, anticipating, and meeting member needs and concerns
• Documents members’ current healthcare services and new service requests
• Ensures members continue to receive current healthcare services as they transition to CCA/CareSource through healthcare provider outreach and education
• Schedules new members’ initial nurse intake visits
• Utilizes communication skills such as motivational interviewing to gain agreement from members to participate in the onboarding process, persistently forging trusting relationships and engaging individuals not readily interested in connecting with CCA/CareSource
• Utilizes established workflows and collaborates with internal and external stakeholders and healthcare providers
• Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's Degree or relevant experience in call center and/or Medicare/Medicaid plan required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Five (5) years of relevant experience required
• One (1) year working in outreach or in the community with individuals who have behavioral, medical, social, or interpersonal complexities impacting their lives required
• Experience working in a multi-cultural setting required
• Experience using motivational interviewing techniques in a professional setting required
• Experience identifying unmet healthcare needs and escalating to the appropriate individual preferred preferred
• Experience with electronic medical record and care management systems strongly preferred preferred

Competencies, Knowledge and Skills:

• Demonstrated understanding of the community served
• Familiarity with data entry and querying databases to identify key information about members
• Excellent communication skills, including the ability to convey information clearly telephonically and in a culturally sensitive manner
• Strong interpersonal and customer relation skills, including active listening skills, dependability, and responsiveness
• Compassionate, understanding, and patience
• Motivates, empowers, inspires, and collaborates with members while effectively establishing boundaries by clarifying roles, expectations, and deliverables
• Ability to develop and maintain positive working relationships with peers, supervisors, and other organizations
• Knowledge of some medical terminology preferred
• Ability to multitask and ensure all work is completed thoroughly and completely in a fast-paced environment with competing demands
• Basic computer skills
• Professional, comprehensive, clear documentation
• Familiarity with Microsoft Office programs: Outlook, Calendar, Word
• Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services.

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:
$47,400.00 - $76,000.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type:
Hourly

Competencies:
- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.