Member Services Staffing. (5 pages, plus 1 additional page per additional MCO Program bid if the Respondent’s response differs by MCO Program; excluding organizational chart(s)) The MCO must maintain a Member Services Department to assist Members and Members’ representatives in obtaining Covered Services as described in Section 8.1.5.
Member Services Staffing. (5 pages, plus 1 additional page per additional MCO Program bid if the Respondent’s response differs by MCO Program; excluding organizational chart(s)) The MCO must maintain a Member Services Department to assist Members and Members’ representatives in obtaining Covered Services as described in Section 8.1.5.
1. Provide an organizational chart of the Member Services Department, showing the placement of Member Services within the Respondent’s organization and showing the key staff within the Member Services Department.
2. Explain the functions of the Member Services staff, including brief job descriptions and qualifications.
3. Describe the curriculum for training to be provided to Member Services representatives, including when the training is conducted and how the training addresses:
a. Covered Services, including Behavioral Health Services and Community-based Long Term Services and Supports;
b. MCO Program requirements;
c. Cultural Competency; and
d. providing assistance to Members with limited English proficiency.
4. Identify the turnover rate for Member Services staff in the past two (2) years. A Respondent operating any HHSC MCO Program must provide the staff turnover rate for each of its MCO Programs. A Respondent not currently operating an HHSC MCO Program must provide its Member Services staff turnover rate for a comparable managed care program and identify the managed care program.
5. For STAR+PLUS only, identify the number and professional background of Member Services staff that the Respondent intends to dedicate to the Service Coordination function.
6. Identify the percentage of Member Services staff who will be physically located in the Service Area. A Respondent submitting a multi-program response must clearly indicate any differences in the Respondent’s Member services approach across each of the MCO Program bid.
Member Services Staffing. 1. OhioRISE Plan's member services staffing must be sufficient to designate at least one full-time member relations staff position to serve as the contact to address barriers identified by members during quality improvement projects aimed at improving member outcomes.
2. Member services staff may be shared positions with an Ohio Medicaid MCO and/or MyCare Ohio Plan.
3. At least one full time member services staff must be dedicated to OhioRISE Plan's functions, if the OhioRISE Plan is affiliated with an Ohio Medicaid MCO and/or MyCare Ohio Plan.
