POSITION SUMMARY

Addresses and resolves provider issues and ensures providers are kept up to date on policies/procedures and any contractual changes. Coordinates provider education and training. Provides information and education on Medi-Cal managed care and Community Health Group (CHG) to Medi-Cal beneficiaries, community based organizations and the general public. Cultivates and sustains positive working relationships with providers and with community organizations serving potential members. Enrolls Medi-Cal beneficiaries interested in joining CHG.

COMPLIANCE WITH REGULATIONS

Works closely with all necessary departments to ensure that utilization management processes, programs and services are accomplished in a timely and efficient manner. Works in accordance with CHG policies and procedures, and in compliance with applicable state and federal regulations, including CMS, DMHC and DHCS.

RESPONSIBILITIES

• Enhances the visibility of the organization by making individual and group presentations, and outreach to providers, provider staff and staff of community organizations.
• Establishes and maintains positive relationships and open lines of communication with providers to ensure concerns are addressed on a timely basis by visiting assigned provider sites on, at a minimum, a weekly basis.
• Addresses and resolves provider issues related to day-to-day operations.
• Provides and interprets information, updates, and alerts to ensure providers are effectively informed on various procedures/issues related to Claims, Customer Service, HEDIS and others.
• Works with Claims, Customer Service, Contracting and other departments to ensure provider issues related to contract terms and rates are resolved and administered correctly.
• Implements plan policies and procedures and provides input on revisions to policies related to providers. 
• Promotes CHG's Medi-Cal health plan by organizing and participating in community health fairs and other events.
• Enrolls Medi-Cal beneficiaries interested in joining CHG.
• Supports team effort by performing other duties as assigned or requested; participating in meetings and on committees; attending work shops, training and seminars; continues professional development; networking; following corporate, division, personnel and safety policies and procedures.
• Maintains product and company reputation and contributes to the team effort by conveying professional image at all times.

  EDUCATION

• Bachelor’s degree preferred.
   
  EXPERIENCE/ SKILLS                                                               
• Current CA driver's license, proof of auto insurance and working car.
• One year successful sales experience.
• Two year successful community outreach experience, preferably related to Medi-Cal and/or Medicare.
• Knowledge of Medi-Cal managed care plan eligibility requirements and Community Health Group programs and services.
• Familiarity with community social service organizations and groups.
• Bilingual ability in Spanish or Vietnamese required.
• Self-directed; ability to recognize and capitalize upon opportunities to promote CHG programs and services in many different venues.
• Knowledge of Microsoft programs (Word, Excel, Access, etc.)
• Excellent written, verbal and telephone skills.
• Ability to analyze program requirements and regulations, understand contract language and educate providers on related issues.
• Able to manage multiple tasks simultaneously.
• Ability to identify issues and resolve complex problems with internal and external customers.
• Conducting successful sales presentations.
• Making individual and group presentations.
• Ability to prepare materials and train staff.
   
  PHYSICAL REQUIREMENTS
• Frequent driving
• Public speaking.
• Will be required to work evenings and/or weekends and to carry needed equipment for community events, in personal car (e.g., canopy, helium tank(s), materials, etc.).
• Lifting and carrying up to 30 lbs.