A care management application to track, monitor and enhance the patient care process. This system houses the Health Risk Assessments and notifications (authorizations) for health plan members.
What is CareOne?
100
This is a person who argues for or supports a cause or policy.
What is an Advocate?
100
The IVR Tag indicates what the Member recently selected within the Natural Language menu. Think of it as the reason the member is calling in the first place. Often has called 30 minutes or 31 minutes to 36 hours.
What is a Repeat Caller?
100
Responding to the consumer's asked and not asked needs in the first call.
What is First Call Resolution?
100
Services that help people make healthy changes in their lifestyles, habits and relationships.
What is Behavioral Health?
200
An application used to transfer and conference phone calls and interact with our members
What is VCC?
200
This helps to gauge the service advocates provide to members.
What is UES Surveys?
200
The IVR Tag indicates what the Member recently selected within the Natural Language menu. Think of it as the reason the member is calling in the first place. it identifies members who have called within the last 30 days approximately:3-4 times, 5-8 times, 9 or more times.
What is a Frequent Caller?
200
Providing further information about immunizations, preventive screenings or if a member mentions a trigger word unrelated to a program
What is Health Education?
200
Helping members achieve better health outcomes by identifying and scheduling preventive care.
What is Healthcare Effectiveness Data and Information Set (HEDIS) Gaps In Care?
300
Use this application to inform members of preventive health services that the plan has available. Also, you use this tool to track compliance and inform members of upcoming physical examinations, screenings and so forth.
What is UTD (Universal Tracking Database)?
300
Reviewing benefits such as copays, deductibles, and coinsurance with consumers.
What is Quoting Benefits?
300
Informs the advocate that the member is returning an _________ call. This call originates from one of two sources.
What is Outbound Call Back?
300
The computer prompted way the calls get routed.
What is IVR (Interactive Voice Response)?
300
Assists members in getting healthier and motivates them to accomplish health goals they may not have otherwise achieved on their own
What is a Health Coach?
400
This application is a web-based scheduling tool used within Health Management Solutions to schedule member appointments with internal Wellness and Clinical Program Operations teams.
What is MyHealthDirect?
400
This person is the first tier of inbound consumer navigators and works with the member to assist with benefits and claims related inquiries. They can also address simple opportunities and respond to simple alerts.
What is a Plan Advocate?
400
Identifies when the advocate has an opportunity to welcome a _____ member to the health plan.
What is New member?
400
Communicating in a warm and friendly way.
What is Positive Tone?
400
This program serves as a means for helping consumers achieve wellness and autonomy through advocacy, communication, education, identification of local resource and service facilitation.
What is High-Risk Case Management?
500
This tool creates a profile for the member. It uses a natural language main menu to assist in routing calls to the appropriate advocate. It helps with our concierge types of services.
What is Conversation Manager?
500
This involves taking complete ownership of experience, providing follow-up to ensure a resolution, and initiating outreach to proactively engage consumers.
What is Advocate4Me Service Model?
500
The service alert informs the advocate of an opportunity to speak to a member regarding an open ______, _______ or ________.
What is Open Appeal, Grievance and/or Complaint?
500
Positive changes in a consumer's life like having a baby, marriage, or a successful surgery.
What is a Positive Live Event?
500
This is a person who works with member through a series of personalized telephonic interactions to set goals and promote healthy behavioral changes for wellness products.