Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)
The Members Matter Supervisor is responsible for staffing, workload management and development of the Members Matter team. This position also handles the most complex member-related concerns and issues.
Handle escalated calls to investigate and resolve access and cultural sensitivity issues (identified by MCO staff, State staff, providers, advocate, organizations, and members.)
Handle escalated calls involving formal and informal grievances to address trends or specific problem areas of access and care delivery. Participate on the MCO Grievance Committee. Give direction to investigate trends.
Execute recommended policy and procedural changes for improved member access and quality of care. Review higher order changes with senior management for engaging State partners. These recommended changes can be for both internal administrative policies and subcontracted providers.
Take ownership when issues need to be escalated or CBO wants to talk to a member of management. Act as the contact for member advocacy groups. Work to get agreed changes implemented.
Handle escalated issues for services that the Health Plan does not ordinarily cover (e.g., same day transportation; out of network provider.)
Attend monthly and quarterly meetings to review quality of service, Health Plan metrics; the kinds of calls that come into the hotline, etc., to ensure that members perspectives are represented.
Coordinate meetings to provide ongoing training and educational materials for the HMO staff and providers. The purpose of these materials is to enhance staff understanding of the values and practices of all cultures with which the MCO interacts.
Handle escalated issues regarding to release of medical records.
Respond to escalated hotline complaints of the member or a provider, the State or an organization.
In peak times, make outbound calls to new members introducing UnitedHealthcare and services such as Health Risk Assessments.
Support the Member Relations Team during community events and member education initiatives. Handle benefits issues/eligibility as subject matter expert.
Maintain responsibility for overall evaluation of the MCO internal advocacy plan. Monitor any contracts the MCO may enter into for external advocacy with culturally diverse associations or agencies. Train the associations or agencies and to ensure their input into the MCOs advocacy plan.
Provide ongoing input to the MCO management on how changes in the MCO provider network will affect member access to medical care, member quality and continuity of care. Participate in the development and coordination of plans to minimize any potential problems that could be caused by provider network changes.
Review and approve the MCOs informing materials (member related materials only such as newsletters; provider updates; events) to be distributed to members. Assess clarity and accuracy. Modify as necessary after the States review
Ensure that team is appropriately staffed to meet state requirements.
Manage hiring, development, and performance of the team.
Set team direction, resolve problems and provide guidance to members of the team
Adapt departmental plans and priorities to address business and operational challenges
Influence or provide input to Health Plan forecasting and planning activities
Carry out supervisory responsibilities in accordance with the UHGs policies and applicable laws
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.