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Member Services Representative
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- The MSR also assists in the case management of Health Service Utilization, Care Management, Radiology Benefit Manager, Transportation coordination, and the Pharmacy Department, by being the Plan's point of contact for the member and provider/pharmacies in the facilitation and coordination of services with the appropriate provider.
- CenCal Health's MSR must embrace CenCal Health's mission and to provide service to CenCal Health's Medi-Cal membership which consists of the underserved and vulnerable populations such as the aged, blind, disabled, Foster Care Children, Medi-Care - Medi-Cal and Long-Term Care.
- Provide customer service in a queue environment within established service levels to all CenCal Health members, advocating on their behalf in assisting with Primary Care Physician selection, obtaining appointments, transportation and interpreter services, coordination of care, referrals to County Mental Health agencies, pharmacy issues, complete documentation of complaints/appeals while providing education of program benefits;
- Respond to members' concerns that include complaints and appeals; identify and assess concurrent care issues, initiate appropriate action required for the immediate resolution including forwarding to department designee for coordination with Health Services; documentation of complaint/ appeal and forward to the grievance unit for investigation and resolution;
- Establish and maintain effective and cooperative working relations with internal health plan staff, and outside collaborative agencies such as DSS, Public Health Department, Tri-Counties Regional Centers, California Children's Services, Public Authority, Alcohol Drug and Mental Health for SB County and Mental Health Services for SLO County, Social Security Administration and network providers;
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