Member Services Director. Contractor shall have a full-time Member Services Director, who shall: (i) direct the community relations functions of the health plan, (ii) coordinate communications with Enrollees, and (iii) act as an Enrollee advocate, assisting Enrollees when necessary to access culturally competent, high quality integrated medical and behavioral health care.
Member Services Director. The Member Services Director is responsible for coordinating communications with members, resolving member inquiries and problems, and meeting member service requirements as required in this Agreement. The Member Services Director must also:
Member Services Director. 1. The Member Services Director is responsible for coordinating communications with members, resolving member inquiries and problems, and meeting member service requirements as required in this Agreement. The Member Services Director may be a shared position with an Ohio Medicaid MCO and/or MyCare Ohio Plan. The Member Services Director must also: Ensure that members impacted by population health initiatives, such as quality improvement projects, are included on the project team to identify member perceived barriers and to assist with the design and testing of interventions impacting members; Ensure that member perspectives and feedback are included in evaluations of improvement initiative success; and Ensure that pertinent knowledge obtained through the OhioRISE Plan's population health improvement initiatives is incorporated into member services.
Member Services Director. 1. The Member Services Director is responsible for coordinating communications with members, resolving member inquiries and problems, and meeting member service requirements as required in this Agreement. The Member Services Director must also: Ensure that members impacted by population health initiatives, such as QI projects, are included on the project team to identify member perceived barriers and to assist with the design and testing of interventions impacting members; Ensure that member perspectives and feedback are included in evaluations of improvement initiative success; and Ensure that pertinent knowledge obtained through the MCO's population health improvement initiatives is incorporated into member services.
Member Services Director. The Contractor must employ a full-time individual responsible for coordinating communications with enrollees and other enrollee services such as acting as an enrollee advocate. This position shall devote sufficient time to the Illinois account. There shall be sufficient member service staff to enable enrollees to receive prompt resolution of their problems or inquiries.
Member Services Director o A Provider Services Director. o A Provider Relations Liaison. o A Grievance/Complaint Coordinator. o Compliance Officer. o A Prior Authorization/Pre-Certification Coordinator who is a physician, registered nurse, or physician’s assistant licensed in the State of Georgia. o Sufficient staff in all departments, including but not limited to, Member services, Provider services, and prior authorization and concurrent review services to ensure appropriate functioning in all areas. • The Contractor shall conduct on-going training of staff in all departments to ensure appropriate functioning in all areas. • The Contractor shall comply with all staffing/personnel obligations set out in the RFP and this Contract, including but not limited to those pertaining to security, health, and safety issues.
Member Services Director a. Coordination of communications with Enrollees and other Enrollee services such as acting as an Enrollee advocate.
