Therapy Management
- Accept ownership for managing new and existing therapy requests.
- Comprehensively assess member treatment needs and collaborate with providers and specialty pharmacies to prioritize memberโs therapy needs.
- Maintain accurate and thorough documentation of all interactions and therapy updates.
- Continuously monitor and evaluate member's therapy plans and progress.
- Balance multiple responsibilities including case management, and inbound and outbound contact while demonstrating skill flexibility to ensure seamless service delivery.
Member Advocacy
- Take the time to understand each member's unique needs, preferences, and circumstances.
- Advocate for members' needs and preferences in therapy decision-making processes.
- Assist members in navigating barriers and explain their options for receiving their medications.
- Provide members with information and resources to help them make informed decisions about their therapy options. Empower members to participate in their treatment planning and decision-making process actively.
- Advocate for adjustments to therapy plans or additional support services if needed to optimize outcomes and ensure members receive the care they need.
Case Resolution and Problem-Solving
- Resolve member cases and inquiries in a timely and efficient manner, demonstrating strong critical thinking skills and attention to detail.
- Review and resolve next-level questions or concerns from members, providers, and pharmacies.
- Critically evaluate scenarios, anticipate potential challenges, and adapt your approach to meet member's evolving needs effectively.
Communication and Collaboration
- Communicate member progress by proactively informing members of their therapy status, and therapy options and intervening in crises for the member providing personalized communication.
- Manage communication with providers and consistently ensure professional and empathetic communication, fostering positive relationships and ensuring a high level of member satisfaction.
- Work closely with other departments to coordinate resources and address member inquiries or concerns effectively.
Requirements
- Have at least 3 years of experience in the healthcare industry, focusing on care coordination, member advocacy, or related roles.
- Demonstrate 3 or more years of customer service experience, case management preferably in healthcare. Call center experience is a plus.
- Proven experience working in a high-volume, fast-paced, evolving team environment.
- Ability to problem-solve, positively adapt to changing working conditions and multi-task.
- You are passionate about improving healthcare and helping people and have demonstrated success in a similar role.
- You are an exceptional communicator who can quickly get up to speed with the VIVIO Health program and effectively articulate its benefits.
- You are responsible and reliable and take ownership of your work while looking to constantly improve your performance.
- High attention to detail
- Experience with Amazon Connect is desirable
- High school diploma or GED.
- Available to work a full-time role between the hours of 6 am PT- 5 pm PT (9 am ET-8 pm ET)
- Bilingual is a plus.
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VIVIO Health
VIVIO Health uses data and technology to deliver superior health outcomes for individuals while reducing pharmacy benefit costs for our employer customers.
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