The Program

Included Health offers a transformative care and case management model with ourDedicated Team model. Our program addresses the ongoing clinical needs of members with a robust, physician-led, multidisciplinary Included Health care team that supports a range of administrative and clinical needs. This high-touch, clinical care coordination and support service is offered to a specific population, from low/rising risk to high complexities and members with acute episodic needs. 

The Role

We’re looking for someone who believes that each and every member deserves world-class service and goes above and beyond to make sure that service is delivered. Our Member Advocates have a demanding job, helping individuals navigate their healthcare, but the demands are worth the rewards. This is one of those rare opportunities where your work will help save lives and truly enrich others. Member Advocates are the most visible representatives of our mission to raise the standard of healthcare for everyone. They work in collaboration and continuous partnership with our members, their family/caregiver(s), our clinical care team, and our support teams. The Member Advocate is responsible for consulting with members and determining their needs, assisting clinicians in developing care plans with health goals in mind, and coordinating relevant member services. If you’re a highly empathic, driven individual with a strong interest in making a real difference to people, we want to hear from you. 

Our Member Advocates are on the front lines of our member care, and we need your detail oriented self to come and join the mission!

Responsibilities:

• Answer inbound calls and chats from members, providers, and vendors on our dedicated lines, treating each with empathy and respect
• Verify member’s account information including insurance and benefits navigation
• Conduct provider matching to ensure members have in network (INN) providers and are of high quality
• Complete related administrative tasks such as submitting letters to be sent to members and local providers, follow up calls to provider offices and members to confirm appointments, obtaining signed medical releases, faxing medical releases and clinical summaries to provider offices
• Complete outbound related projects to high opportunity members
• Coordinate care through team huddles as part of an interdisciplinary team to advocate on behalf of patients, care team, family/caregiver(s), payers, and community resources using care plan development and adherence
• Consult with members and discuss their health goals and challenges in order to connect them to quality programs leading toward healthier outcomes, utilizing motivational interviewing/health coaching techniques
• Attend ongoing training and courses to keep skills current with new developments in healthcare
• Comply with organizational guidelines and health care laws and regulations
• Enhance clinical outcomes for members by promoting timely access to appropriate care, increase utilization of preventative care and reducing emergency room utilization and hospital readmissions.

Qualifications / Skills:

• Excellent customer service skills - our members are top priority and we are their advocates
• Ability to multi-task and remain flexible in an ever changing environment
• Excellent verbal skills are essential as you’ll need to explain our services with confidence, speak clearly, confidently, and have a friendly phone demeanor with the ability to anticipate needs
• Effective time management, demonstrating high organization and attention to detail with tasks and deadlines
• Exceptional business writing skills, including accurate spelling and grammar. Not only will you talk to people on the phone, you’ll communicate with members and doctors in writing as well
• Proficiency with technology; experience with Google apps, Apple products, and customer relationship management software a plus
• Ability to independently manage one’s own workload while maintaining quality targets, department metrics, and exceeding member expectations
• Ability to work interdependently with resourcefulness when faced with challenges and opportunities to collaborate
• Demonstrated ability to think critically and problem solve complex situations
• Be empathetic. You’ll work with members and their families who are going through challenging times.
• Ability to keep perspective, be empathetic, be efficient and reassure them that you can help is critical to the role
• A sense of humor. We work hard. So we like to laugh a lot, too
• Ability to work from a home office if needed
• Acknowledges member’s rights on confidentiality issues, maintains member confidentiality at all times, and follows HIPAA guidelines and regulations
• Proactively continues to educate self on providing quality care and improving professional skills

Education, Experience, and Licensing Requirements:

• Office and/or customer service experience required
• Familiarity with phone systems and being comfortable with communicating on the phones majority of the day
• Previous experience with Mac products and Google platforms highly preferred
• Credentialed or Licensed in medically related field preferred (i.e., Medical Assistant, Pharmacy Technician, Case Manager, Social Worker)
• Bachelor’s degree or 5 years of relevant experience in healthcare or benefits/insurance organization is preferred, but not required
• Familiarity with motivational interviewing or coaching desiredKnowledge about and connections to community health care and social welfare resources is preferred

This role is a remote opportunity. Due to HIPAA requirements, candidates must reside and work within the United States.

Overnight shifts are listed below; all times listed in Pacific Time (PST):

Tuesday - Saturday: 6:00pm - 3:00am (PST)

Tuesday - Saturday: 9:00pm - 6:00am (PST)

Sunday - Thursday: 6:00pm - 3:00am (PST)

Sunday - Thursday: 9:00pm - 6:00am (PST)

Two training start dates are currently available: August 15 and August 29

Training for the first 3 weeks will be Monday - Friday, from 7am - 4pm (PST).

On your 4th and 5th weeks of training, you will train Monday - Friday, from either 8am-5pm EST (for candidates residing in EST or CST) or 8am-5pm PST (for candidates residing in MST or PST).

Your official, permanent schedule will go into force on your 6th week of employment.

About Included Health

Included Health is a new kind of healthcare company, delivering integrated virtual care and navigation. We’re on a mission to raise the standard of healthcare for everyone. We break down barriers to provide high-quality care for every person in every community — no matter where they are in their health journey or what type of care they need, from acute to chronic, behavioral to physical. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care. It’s all included. Learn more at includedhealth.com.

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Included Health is an Equal Opportunity Employer and considers applicants for employment without regard to race, color, religion, sex, orientation, national origin, age, disability, genetics or any other basis forbidden under federal, state, or local law. Included Health considers all qualified applicants in accordance with the San Francisco Fair Chance Ordinance.