Liaison Jobs in Irvine, CA

Hourly Rate : $23.92 - $33.48 / hr

Offer will be made by the client based on experience and based on their internal scale!

Fully In-Office, Monday to Friday

Job Summary

One of our most prestigous healthcare clients is seeking a highly motivated an experienced TEMP - Member Liaison Specialist to join our team. The Member Liaison Specialist (Customer Service) will provide member service to seniors, persons with disabilities or chronic conditions, persons without housing and persons under the age of twenty-one who participate in the Whole-Child Model program. The incumbent will serve as a liaison between members, health networks, providers and community-based organizations to facilitate access to services and help resolve health care and psychosocial issues.

Position Information :

Duties & Responsibilities :

• 85% - Member Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department. Assesses members’ concerns to identify psychosocial or health care issues and facilitate an appropriate resolution. Intakes information from members, both over the phone and / or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines. Coordinates members’ health care and social service needs both within and outside the health network during the original interaction. Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals / authorizations for medical care related to services covered under the Whole-Child Model program. Guides members in understanding and accessing the benefits under the Whole-Child Model program. Maintains documentation of member cases within the FACETS system. Initiates referrals to internal and external care management departments and government agencies. Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services.
• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals / priorities for the department.
• Assesses members’ concerns to identify psychosocial or health care issues and facilitate an appropriate resolution.
• Intakes information from members, both over the phone and / or in person, to complete requests for assistance cases, grievances and appeals, per departmental guidelines.
• Coordinates members’ health care and social service needs both within and outside the health network during the original interaction.
• Addresses member and provider inquiries, questions and concerns in all areas, including enrollment, claims, benefit interpretation, coordination of care and referrals / authorizations for medical care related to services covered under the Whole-Child Model program.
• Guides members in understanding and accessing the benefits under the Whole-Child Model program.
• Maintains documentation of member cases within the FACETS system.
• Initiates referrals to internal and external care management departments and government agencies.
• Communicates with community-based organizations, health networks, providers and vendors on behalf of members to resolve disputes and helps coordinate access to care and investigates issues preventing members from receiving medical benefits and services.
• 10% - Administrative Support Collaborates with interdepartmental staff in call resolution as needed. Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines. Meets all regulatory key performance indicators, first call resolution requirements and business objectives
• Collaborates with interdepartmental staff in call resolution as needed.
• Identifies calls needing case management or escalation to a supervisor, manager or director and routes them according to established guidelines.
• Meets all regulatory key performance indicators, first call resolution requirements and business objectives
• 5% - Completes other projects and duties as assigned.

Minimum Qualifications :

Preferred Qualifications :

Required Licensure / Certifications :

Knowledge & Abilities :

Physical Requirements (With or Without Accommodations) :

Work Environment :

If located at the 500, 505 Building or a remote work location :

If located at PACE :

If located in the Community :

The Midtown Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.