The Member Services Manager should possess strong supervisory/leadership skills including planning, organizing, directing, and coordinating the activities of Patient Advocacy and Customer Service. Requirements include a thorough understanding of the US Family Health Plan benefit structure, TRICARE Manuals, and Policies and Procedures of the Health Plan. Must display good communication and conflict resolution skills, display an abiding empathy for members. Must be able to maintain a customer first attitude, resolving member issues within the structure and framework for program administration and in compliance with regulatory considerations. Must also be able to develop and manage the department within budgetary guidelines.
Plan, implement and manage the Patient Advocacy and Customer Service Programs.
Supervise and manage the selection, training, development, appraisal, and work assignments of personnel.
Analyze call flow and forecast requirements to support daily call activity
Acts as liaison with Primary Care Net to ensure 24 hour phone coverage
Conduct monthly staff meetings
Develop monitoring systems, tools and processes to evaluate and improve the quality of services delivered within the Member Services department.
Submit daily, weekly, monthly, quarterly and annual reports as requested and as per contract specifications
Complete evaluations of direct reports
Serves in the capacity of a Co-Risk Manager for the USFHP
Participates in member education and public relations/marketing efforts of USFHP
Participate in policy development and strategic planning as requested by Director of Quality Services
Management and oversight of member and prospective member presentations and Public Relations meetings with local military and retiree associations
Establishes and coordinates management of the grievance resolution process to monitor, track, report, and improve patient satisfaction
Investigates and responds to Congressional Inquiries
Train and oversee development of Patient Advocacy and Customer Service staff
Act as liaison with various government offices including courtesy visits to Local Congressional Offices
Evaluate current grievance resolution process and implement changes as required
Maintain governing TRICARE Manuals, track changes, and notify and educate USFHP staff about the plan benefit changes.
Participates in plan wide activities and collaborates with other departments as needed to ensure optimum delivery of care and services to members
Ensures department's compliance with DoD, regulatory and URAC standards Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals
Follows the CHRISTUS Guidelines related to the Health Insurance Portability and Accountability ACT (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Collaborate with all other departments as appropriate and required to facilitate the completion of tasks/goals
College degree preferred or 7-10 years work related experience
Knowledge of healthcare management and managed care operations
Proficient in use of word processing, spreadsheet applications
Typing skills of 50wpm
Working knowledge of statistical processes and methods
Minimum five years healthcare related experience
Prior management experience
At least two years experience in a managed care organization or health plan
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.