Member Services Manager Sample Clauses

Member Services Manager. The Contractor shall employ a Member Services Manager who is dedicated full-time to member services for the Contractor’s Indiana Medicaid product lines, which shall be available via the member helpline and the member website, including through a member portal. The Member Services Manager shall, at a minimum, be responsible for directing the activities of the Contractor’s member services, including, but not limited to, member helpline telephone performance, member e-mail communications, member education, the member website, member outreach programs, development, approval and distribution of member materials. The Member Services Manager manages the member grievances and appeals process, and works closely with other managers (especially, the Quality Manager, Utilization Manager and Medical Director) and departments to address and resolve member grievances and appeals. The Member Services Manager shall oversee the interface with the Enrollment Broker regarding such issues as member enrollment and disenrollment, member PMP assignments and changes, member eligibility and newborn enrollment activities. The Member Services Manager shall provide an orientation and on-going training for member services helpline representatives, at a minimum, to support accurately informing members of how the Contractor operates, availability of covered services, benefit plans and limitations, health screenings, emergency services, PMP assignment and changes, specialty provider referrals, self-referral services, preventive and enhanced services, well- child services and member grievances and appeals procedures. The Member Services Manager, in close coordination with other key staff, is responsible for ensuring that all of the Contractor’s member services operations are in compliance with the terms of the Contract. For more information regarding the member services program requirements, see Section 4.
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Member Services Manager. The Contractor shall employ a Member Services Manager who is dedicated full-time to member services for the Contractor’s Healthy Indiana Plan product line, which shall be available via the member helpline and the member website, including through a member portal. The Member Services Manager shall, at a minimum, be responsible for directing the activities of the Contractor’s member services, including, but not limited to, member helpline telephone performance, member e-mail communications, member education, the member website, member outreach programs, development, approval and distribution of member materials and employer outreach for HIP members. The Member Services Manager manages the member grievances and appeals process, and works closely with other managers (especially, the Quality Manager, Utilization Manager and Medical Director) and departments to address and resolve member grievances and appeals. The Member Services Manager shall oversee the interface with the Enrollment Broker regarding such issues as member enrollment and disenrollment, member PMP assignments and changes, member eligibility and newborn enrollment activities The Member Services Manager shall provide an orientation and on-going training for member services helpline representatives, at a minimum, to support accurately informing members of how the Contractor operates, availability of covered services, benefit plans and limitations, health screenings, emergency services, PMP assignment and changes, specialty provider referrals, self-referral services, preventive and enhanced services, POWER Account services, GTW services, and member grievances and appeals procedures. The Member Services Manager, in close coordination with other key staff, is responsible for ensuring that all of the Contractor’s member services operations are in compliance with the terms of the Contract. For more information regarding the member services program requirements, see Section 7.
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Member Services Manager. A dedicated, full-time professional located in Mississippi to be responsible for Member Services functions.
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Member Services Manager. The Contractor must employ a Member Services Manager. The Member Services Manager must, at a minimum, be responsible for directing the activities of the Contractor’s member services, including, but not limited to, member helpline telephone performance, member e-mail communications, member education, the member website, member outreach programs and development, approval and distribution of member materials. The Member Services Manager must oversee the interface with the Enrollment Broker regarding such issues as member eligibility, enrollment and disenrollment. The Member Services Manager must provide an orientation and on-going training for member services helpline representatives, at a minimum, to support accurately informing members of how the Contractor operates, availability of covered services, benefit limitations, health screenings, Emergency services, preventive and enhanced services, disease management, care management and complex case management services and member grievances and appeals procedures. The Member Services Manager, in close coordination with other key staff, is responsible for ensuring that all of the Contractor’s member services operations are in compliance with the terms of the Contract. For more information regarding the member services program requirements, see Section 4.0.
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Member Services Manager. Individual shall be responsible for provision of all MCO Member Services activities. The manager shall have prior experience with Medicaid populations.
Sample 1
Member Services Manager. Shall provide oversight of the Member services functions of the Contract, including, but not limited to, Member helpline telephone performance, Member e-mail communications, Member education, the Member website, Member outreach programs, development, approval and distribution of Member materials. The Member Services Manager shall oversee the interface with the Agency or its Subcontractors regarding such issues as Member enrollment and Disenrollment.
Sample 1
Member Services Manager. The Contractor shall employ a Member Services Manager who is dedicated full-time to member service product lines, which shall be available via the member helpline and the member website, including through a member portal. The Member Services Manager shall, at a minimum, be responsible for directing the activities but not limited to, member helpline telephone performance, member e-mail communications, member education, the member website, member outreach programs, development, approval and distribution of member materials. The Member Services Manager manages the member grievances and appeals process, and works closely with other managers (especially, the Quality Manager, Utilization Manager and Medical Director) and departments to address and resolve member grievances and appeals. The Member Services Manager shall oversee the interface with the Enrollment Broker regarding such issues as member enrollment and disenrollment, member PMP assignments and changes, member eligibility and newborn enrollment activities. The Member Services Manager shall provide an orientation and on-going training for member services helpline representatives, at a minimum, to support accurately informing members of how the Contractor operates, availability of covered services, benefit plans and limitations, health screenings, emergency services, PMP assignment and changes, specialty provider referrals, self-referral services, preventive and enhanced services, well-child services and member grievances and appeals procedures. The Member Services Manager, in close coordination with other key staff, is responsible for ensuring of the Contract. For more information regarding the member services program requirements, see Section 4.
Sample 1
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Member Services Manager. The MCO must employ a Member Services Manager who is dedicated full-time to the Hoosier Healthwise program. This Manager must, at a minimum, be responsible for directing the activities of the MCO’s member services, member helpline telephone performance; member education and outreach programs and member materials development, approval and distribution and serve as the primary interface with the State’s fiscal agent and enrollment broker regarding such issues as member enrollment and disenrollment, member PMP changes, member eligibility and newborn enrollment activities. This Manager must provide an orientation and on-going training for member services helpline representatives, at a minimum, to support accurately informing members of how the MCO health plan operates, availability of covered services, benefit limitations, health needs assessment (HNA) screening, emergency services, PMP assignment, specialty provider referrals, self-referral services, preventive and enhanced services, well-child services and member grievances and appeals procedures. The member services manager, in close coordination with other key staff, is responsible for ensuring all of the MCO’s member services operations are in compliance with the terms of the MCO’s contract with the State. For more information regarding the member services program requirements, see Section 3.0 of this Attachment.
Sample 1

Related to Member Services Manager

  • ADMINISTRATION SERVICES When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. Site of Care Program For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

  • Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity

  • Call Center Services Answer telephone inquiries during mutually agreed upon hours each day on which the Fund is open for trading. In the event that the Fund plans to be open on a business day when the New York Stock Exchange is to be closed, the Fund shall provide the Transfer Agent with reasonable advance notice and the parties shall discuss the call center resources available for such day. The Transfer Agent shall answer and respond to inquiries from existing Shareholders, prospective Shareholders of the Fund and broker-dealers on behalf of such Shareholders in accordance with the instructions provided by the Fund to the Transfer Agent for purpose of fulfilling its duties under this Agreement, including, accepting transaction requests on behalf of the Fund.

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