Case Management Lead Representative - Evernorth Health Services - Remote

Case Management Lead Representative – After Hours Duties

The Advocate role is a non-clinical customer service position within an inbound call center that supports Evernorth Behavioral Health. Advocates are responsible for handling inbound calls from both members and providers or their office support staff regarding mental health or substance use disorder services. Advocates guide and assist the members and providers to help them work with Cigna/Evernorth more effectively and ensure first call resolution. The types of calls an Advocate service may include but are not limited to: triaging and assessing the need for clinical intervention, inquiries about provider referrals and access to care, eligibility, and benefits. Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call. Independent problem solving, multitasking, and technical savvy are essential in order to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner. The nature of discussions within the Behavioral Advocate role often delve into personal and sensitive topics with members. It demands a nuanced understanding of mental health and substance use issues.

Responsibilities

The primary responsibility of this role is to answer inbound calls from members and providers. The work environment is structured, and the majority of the day will be spent answering these calls from a queue. Occasional outbound calls may be necessary for issues requiring follow-up. Within a call an Advocate may:

• Use active listening and empathy skills to triage and assess for risk of harm and substance use concerns
• Coordinate with multiple matrix partners, and facilitate seamless hand offs to clinical partners for timely support
• Communicate eligibility, generate a list of provider referrals, quote benefits, or advise of authorization requirements for services
• Write authorizations to ensure claims are paid correctly
• Provide follow-up on issues by making outbound calls when necessary
• Send resources to members and providers via email
• Submit a complaint on the members or provider's behalf
• Independently problem-solve to ensure accurate information is given, and exceptional customer service and first call resolution is achieved

Qualifications

Bachelor's degree in the mental health field or psychology/social work-related field (family communications, health coaching, community/public health or other related major), is strongly preferred. Alternatively, a bachelor's degree in another field or equivalent work experience, combined with 2+ years of experience in the behavioral health field will be considered. Customer Service experience. Prior experience working in a patient-focused mental health environment preferred. Ability to maintain a professional and positive image to external customers. Candidate must possess superb interpersonal communication skills. Effective listening and organizational skills, with the ability to manage multiple tasks. Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several proprietary systems. Independent problem-solving skills. Able to excel and/or have prior successful experience in a virtual team environment. Strong time management skills. Ability to type effectively and have strong PC skills.

Training

Initial training for this position will be focused on member calls regarding triage, referrals, benefits, eligibility, and other support resources. Additional training on provider calls will take place once an Advocate becomes proficient in speaking to members. Training hours are Monday through Friday 10AM – 7:00 PM CST.

Work Schedule

Once training is complete, hours will change to Wednesday, Thursday, Friday 5am-3pm CST, Saturday 6am-4pm CST. 12% Shift Differential for the Saturday Shift.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 19 - 29 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan.

Benefits

We want you to be healthy, balanced, and feel secure. That's why you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.