Dispositions
You request a callback from CM for a member.
Transfer to Care Management
Where do we leave our notes in a member's dynamo account?
Journal/CM activity tracking
If this is our 5th consecutive attempt contacting the member and we get voicemail all 5 times, how would you dispo the call?
Manual Max Attempts Final.
How long do you wait if a member puts you on hold?
5 minutes
How long does it take for a non urgent resource gap to be answered?
up to 7 business days
When a member doesn't want our help, but asks to be transferred to MS.
Transfer to MS closed
What do you do if a member needs to update their address?
Update the address in Dynamo and QNXT and advise they need to update with the state and provide the member with that number
If a member has been assigned to CM, when can REACH team start assisting them again?
After they are discharged from CM
If you called a member and they were wavering on whether they wanted to let you help them, what would you say to try to convince them to do the HRSN and see what programs you could find for them?
Provide understanding to the member, give them the opportunity to call us back to verify who we are.
Where do you find the transfer codes for MS and EH?
Member reach Home page, desktop and job aides, contact information, contact info_hours of operation
Social Risk member says they can't speak right now and doesn't provide an exact time to call them back.
Follow-Up
What steps do you take if a member wants you to speak with their son?
Fully verify member, member must give verbal permission, check in QNXT to see if the son is listed as auth rep, if he is not listed add a HIPAA event in Dynamo
When do we address Care Gaps?
When we complete a success story, and no other referrals are open, the dialer will present the verbiage if member has any Care Gaps
What do you say if a member indicates they don't really want to answer a question on the HRSN?
That's not a problem, we can move to the next question or if you don't want to answer any further questions you can let me know what you need help with.
How long does it take for an urgent resource gap to be answered?
48 business hours
Follow-Up, if a member hasn't had a chance to call the organization.
Pending Member-Organization 1 Week
What system and tab can we check to see if a member has HANs?
QNXT, Attributes/Share of cost
If you have After Call Work to do for a member, but it's your break time, would you finish ACW first or go to break? and what needs to be submitted if you go to break late due to a long call?
Go to break first when you come back from break go into ACW and finish your after call work. You need to submit an exception if you go to break late due to a call.
What do you do if a member you call speaks Spanish?
find out if a Spanish agent is available, if not call the translation line, if they are connect the member directly to the agent available.
How long does it take CM to return a callback request?
up to 5 business days
Inbound caller, member wasn't able to get any assistance from a Utility Program, you provide them a new program and you will call back in a week to check in.
Pending Agent-Manual Callback - inbound campaign doesn't speak to follow up and regular campaigns.
If a member asks you to take them out of any future calling from Aetna, what do you do?
Put a DNC alert in QNXT and document QNXT and Dynamo, dispo as Member Declined
Member doesn't have their ID number, what forms of verification can they provide to ensure your HIPAA compliant?
Full Name (required), 2 of the following: DOB, street address (number and street name) with city and state, Telephone number, Zip code, email address
Members needs identified are Housing, Financial, Food, and Employment. What are your next steps? Where do you document and what do you document?
Provide referrals and then connect to EH for further review, if member accepts CM. Document QNXT and Dynamo. Document member's needs, email referrals were sent to, if EH was contacted and how, any additional member information important to member's situation, disposition of the call.
In Dynamo, when looking in the member's journal, what 2 things must be selected to ensure all notes show up?
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