Inquiry Coordinator (KY SKY)

Inquiry Coordinator (KY SKY)

07 Aug 2024
Kentucky, Louisville 00000 Louisville USA

Inquiry Coordinator (KY SKY)

Vacancy expired!

Job DescriptionThe Inquiry Coordinator will have ombudsman-like responsibilities for Kentucky SKY Enrollees, Foster Parents, Adoptive Parents, relatives, Fictive Kin, Caregivers, and Providers, as needed. This position will make independent decisions in a timely manner and provide reporting to the health plan, Department, DCBS, and DJJ on inquiries and complaints made by or on behalf of Kentucky SKY Enrollees and Providers. The Inquiry Coordinator will also provide education to and inform Kentucky SKY Enrollees, Foster Parents, Adoptive Parents, relatives, Fictive Kin, Caregivers, and Network Providers of the protocols for submitting Grievances and Appeals and other processes as defined by the plan.Candidate may reside in the Louisville, Lexington or Frankfort area.Works with internal staff across multiple departments to identify data sources, processes and activities required to meet regulatory and accreditation requirements or meet the objectives of the quality management program. Conducts outreach with complex provider partners to share information to improve health outcomes.This is a telework position with routine in-state travel required, up to 50% of the time. Use of a personal vehicle when traveling in the field. Must have active and valid KY driver's license, reliable transportation, and vehicle insurance.Fundamental ComponentsThe Inquiry Coordinator is responsible for making recommendations related to inquiries and/or complaints for the Kentucky SKY population to the health plan, the Department of Medicaid services, DCBS, and DJJ regarding any changes needed to improve either the actual care provided or the manner in which the care is delivered. It is preferable the candidate has experience working with low-income populations and have demonstrated cultural sensitivity.

Inform Kentucky SKY Enrollees, Foster Parents, Adoptive Parents, relatives, Fictive Kin, Caregivers, and Network Providers of the protocols for submitting Grievances and Appeals.

Initiates and encourages open and frequent communication between constituents. Dissects policies, trends, and workflows which in turn identify areas in need of improvement throughout various departments.

Successfully works across functions, segments, and teams to create, populate, and trend reports to find resolution to escalated cases.

Monitor the Kentucky SKY formal and informal grievances with the grievance personnel to look at trends or major areas of concern; discuss these reports with community advocates and key stakeholders as necessary.

Recommend policy and procedural changes to the health plan’s management including those needed to ensure/improve member access to care and quality of care; changes can be recommended for both internal administrative policies and provider requirements.

Function as a primary contact for member advocacy groups; work with these groups to identify and correct member barriers.

Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of members.

Organize and provide training and educational materials for the health plan’s staff and providers to enhance their understanding of the values and practices of the Kentucky SKY population.

Provide input to management on how provider changes will affect member access and quality/continuity of care; develop/coordinate plans to minimize any potential problems.

Background Experience

3 to 7 years clinical and/or managed care experience in the healthcare industry or quality management.

Bachelor's degree, Nursing degree, or other comparable healthcare experience.

Computer literacy and demonstrated proficiency is required in order to navigate through internal/external computer systems, and MS Office Suite applications, including Word and Excel.

Additional Job InformationAt Aetna Better Health of Kentucky, we reach beyond ensuring access to quality health care by focusing on resilient healing for children and their families. Our vision is to construct local, regional, and state-level coalitions to create a shared, in-common vision of health promoting and resiliency building approaches, to engage and support children to have membership in a family and community, while services and permanency planning are occurring. By keeping families safely together, children in Kentucky SKY will experience less trauma, which leads to better outcomes. To accomplish this, we are looking for people like you who value excellence, integrity, caring and innovation. As an employee, you’ll join a team dedicated to supporting children, young people, parents, and other important partners involved with child protection systems. We value diversity and are dedicated to helping you achieve your career goals.EducationBachelor's degree or equivalent experiencePercent of Travel Required25 - 50%Business OverviewAetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Related jobs

Job Details

Jocancy Online Job Portal by jobSearchi.