Medicare Care Management HRA Support Specialist

About the Role

The Medicare Care Management HRA Support Specialist position involves engaging with Cigna Healthcare Medicare members through phone outreach to evaluate health status, lifestyle, and care coordination needs. The specialist will connect customers to internal Care Management initiatives, provide education on available benefits, assist in scheduling medical appointments, and facilitate handoffs to appropriate care teams. Accurate documentation aligned with regulatory guidelines is critical.

Key Responsibilities

• Perform health risk assessment (HRA) screenings by telephone or process mailed/faxed HRAs.
• Support customers in arranging medical appointments.
• Facilitate connections between customers and case management or community health resources.
• Identify and address care gaps, promoting completion of annual in-person provider visits.
• Inform customers about their plan benefits.
• Direct customer referrals to suitable care management teams based on needs.
• Appropriately escalate any customer concerns or issues.
• Maintain precise documentation for regulatory audits.
• Assist customers in overcoming barriers and navigating healthcare systems.

Required Qualifications

• Minimum education of high school diploma; college degree preferred or equivalent experience in managed care.
• Excellent verbal and written communication skills emphasizing high-quality customer service and care coordination.
• Empathy and the ability to provide emotional support to customers.
• Understanding of various facets of the healthcare system.
• Strong listening abilities and attention to detail.
• Capability to assist customers in problem-solving and resource navigation.
• Motivation for ensuring appropriate care and customer well-being.
• Computer proficiency with Outlook, Excel, Word, data entry, and experience using dual monitors.
• Good interpersonal skills and effective teamwork capabilities.
• Ability to multitask, prioritize, and create actionable plans.

Preferred Qualifications

• Familiarity with Medicare regulatory requirements.
• At least one year of managed care or health services experience, focusing on population health management.
• Experience handling telephone communications and process management.
• Background in conducting HRAs, health screenings, or member assessments.
• Knowledge in educating Medicare members about benefits, care gaps, preventive services, and care management.