Outreaches
Member Engagement
Case Closures
Expectations and Goals
100

_____ days is the duration of the the initial outreach process before closing out the case. 

What is 30 days?

100

In the Initial Outreach process, we get this many days to complete the initial call.

What is within 3 business days?

100

In the U.T.C. process, we are required to have this many attempts prior to closing the case.

What is three phone call attempts?

100

The expectation is to have this many calls daily.

What is 25?
200

In the initial outreach call cycle, _____ outreach calls is needed.

What is 5 outreach calls?

200

For the initial outreach process, we get this many days to complete the first three calls.

What is seven calendar days?

200

This is the expected timeframe for members to be enrolled in the R.I.S.E program before needing to consult for extension? 

What is six months?

200

The expectation is to have this many members engaged annually? 

What is 200?

300

The product that requires a letter after the second U.T.C.

What is the Medicaid product?

300

HIPPA verifiers include.

What is first and last name, mailing address (minimum of street address) and date of birth. 

*Can use the phone number as final verifier but must repeat the phone number on file for you. 

300

For engaged members in the U.T.C. process, 30 days from this date is when the case should be closed. 

What is the last successful contact date?

300

The expectation is to present in Rounds in this frequency.

What is Quarterly

400

Per R.I.S.E guidelines, using CPSUI, these three statuses are able to dial out/call and one status that we cannot.  


What is Not stated, Consent and DNC (Do not call) for can dial out and RND/Wrong number for not being able to dial out?

400

This is needed to flip the case from unenrolled to engaged status.

What is intro tile and answering one questionnaire question.

400

In the U.T.C process for an engaged/enrolled member, You get this many calendar days to complete the second U.T.C call. 

What is 7 calendar days?

400

The expectation to submit a member impact story? 

What is Monthly?

500

In the PDM process, this is needed to be added in the medical chart regardless if the member is reached or not. 

What is a stabilization goal?

500

For enrolled/engaged members, a CM is required to contact a provider in the case that the member experienced these four things.

What is has been inpatient, in observation at hospital, in the ER or has a new provider claim?

500

The four reasons why a case may be closed.

What is the member wants to opt out, member completes all goals, member reached six month timeframe and 30 days of unable to contact?

500

The expectation of this many assigned members and this many engaged members. 

What is 80 assigned cases with 50 cases being engaged?

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