Job Attributes

Work Schedule/Shift

Day

Job ID

5000431782906

Req. No

70032732

Job Title

Manager Member Services

Region

CHRISTUS System Office

Category

Healthcare

Division

Not Defined

Company

CHRISTUS Health

Travel

None

Facility

Corp USFHP-55100

Address

919 Hidden Ridge
Irving, TX  75038
US

Type

Full Time

Apply Now Manager Member Services Job in Irving

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.

MAJOR RESPONSIBILITIES

  • 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

A. Education/Skills

  • 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

B. Experience

  • Minimum five years healthcare related experience
  • Prior management experience
  • At least two years experience in a managed care organization or health plan

C. Licenses, Registrations, or Certifications:

  • RN or RRN preferred
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