ACCESS Member Services Specialist

Job not on LinkedIn

🔥 27 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $54k - $65k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 1%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Vaya Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1972

🛡️ Insurance

💼 Consulting

📦 Logistics

Insurance • Consulting • Logistics

Vaya Health is a North Carolina-based organization that manages services for individuals with behavioral health issues, including mental health and substance use disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). The organization provides Medicaid services tailored for these populations, focusing on a person-centered approach that connects members to the necessary care and support for their unique health and wellness goals. Vaya Health emphasizes collaboration across various care areas to ensure comprehensive support for its members, fostering healthier communities across the region.

📋 Description

• Conduct telephonic screenings and collect demographic information • Provide callers with choices among available providers and link them to appropriate services • Link callers to licensed clinicians for urgent or emergent services when needed • Review and confirm member and recipient eligibility • Schedule appointments within established access-time standards • Handle customer-service calls regarding enrollment, service access, referrals, Social Determinants of Health needs, provider changes, and general information • Provide information about Vaya Partners, its provider network, community resources, and North Carolina Medicaid services • Identify risk indicators and make immediate referrals to Member and Recipient Services Clinicians • Resolve caller questions when possible or explain resolution processes and timeframes • Complete warm transfers and linkages to appropriate parties • Complete call notes, forms, reports, and other electronic documentation during or immediately after calls • Monitor service-system trends and report gaps and needs to management or Provider Network Development staff • Adhere to the NCMT Call Grading Rubric and deliver person-centered, recovery-oriented customer service • Assist with specialized ACCESS Call Center projects and perform other assigned duties

🎯 Requirements

• Bachelor’s degree in a Human Services field and at least two years of experience working with adults or children with serious psychiatric, chemical dependence, or developmental disability in a community mental health center or similar setting, OR bachelor’s degree from an accredited college or university and at least four years of such experience • Must be qualified as a Qualified Professional according to 10A NCAC 27G .0104 • Experience providing mental health, substance abuse services, or intellectual/developmental disabilities • Knowledge of social work principles, techniques, and practices • Knowledge of behavioral health principles and complex treatment and services provision • Knowledge of person-centered and recovery philosophies • Familiarity with mental health, developmental disability, and substance abuse disorders • Knowledge of governmental and private community organizations and resources • Knowledge of laws, regulations, and policies governing LME/MCO operations, human services, and utilization management • Ability to use complex telephone and computer systems and multiple technology systems concurrently during live calls • Ability to document information electronically and complete call notes, forms, reports, and other documentation at the time of call • Ability to communicate clearly and concisely orally and in writing • Ability to establish effective working relationships with community members and provider agency staff • Ability to interact professionally and effectively with upset individuals and those who disagree • Ability to remain professionally responsive in an ethical and sensitive manner • Required confidentiality and compliance training regarding HIPAA, 42 CFR Part 2, and applicable state laws; must sign a confidentiality statement • Must reside in North Carolina or within 40 miles of the North Carolina border

🏖️ Benefits

• Overtime compensation eligibility • Remote, home-based work • Monday–Friday schedule • 40-hour work week • Customer Satisfaction Survey participation at call close (service-quality practice)