Job Requisition Number: 27269. As a national collegiate leader, UC Berkeley’s University Health Services (UHS) provides comprehensive medical, mental health, insurance and health promotion services to all Berkeley students, and a variety of health programs for faculty and staff. Approximately 65,000 visits occur annually including Primary Care, Urgent Care, Occupational Health and Specialty Clinics. Services are designed to minimize the impact of illness, emotional distress and injury on studies and work. Coupled with health promotion and public health programs, UHS reaches all segments of the Berkeley campus community. Learn more about us by visiting uhs.berkeley.edu
Under the direction of the Associate Director for Insurance, this position is responsible for proactive patient navigation for the Student Health Insurance Plan (SHIP). This involves timely communicating with students, especially those with complex care needs or chronic conditions, regarding their benefits, anticipated costs and options, and how to find and connect with appropriate care outside of the Tang Center. This position would be responsible for outreach to students and providers regarding the referral process as well as tracking referrals and whether SHIP members were able to follow their clinician’s care plan. This position works as a member of both the SHIP staff and the UHS Care Management team and collaborates with a number of other clinical care managers in the building. This position influences, shapes and collaborates on the student health benefit programs and may provide training to departments and student communities on SHIP and care coordination.
SHIP referral coordination: •Applies benefit policies and procedures to resolve issues and to address questions. •Works with students with complex needs or chronic conditions to ensure timely access to care. •Assists students with complex care plans to connect to appropriate SHIP networked providers. •Assist students who have established care with non-network providers to connect with networked providers and options. •Follows up with community providers struggling to follow the SHIP referral and health records processes necessary for SHIP benefits to be administered. •Tracks patients referred out for care to see if care was received and if additional referrals required. •Coordination efforts are timely and efficient and done in a manner that is consistent with the principles and values of UHS.
Communication and patient navigation: •Communicates with students and their families regarding SHIP benefits, anticipated costs, and care options when students need multifaceted or complex care outside of UHS. •Provides training and education to departments and community providers regarding the SHIP benefits and referral structure. •Participates in or leads network/provider outreach efforts. •Provides quality customer service to SHIP members
Collaboration: •Works as a member of the SHIP team, especially with SHIP case coordinators handling claims and benefits problems or seeking authorization for services. •Serves as a key member of the UHS Care Management team which involves complex case coordination and consultation with other care managers and case workers in medical and mental health. •Actively participates in warm hand off of SHIP members who may benefit from services of other care managers in the building and takes warm handoffs from those care managers. •Ensures SHIP students are able to maximize SHIP benefits and implement their clinical care plans. •Works in a collaborative manner with others across the organization to prioritize and complete multiple assignments on time. •May be involved with post-hospitalization care coordination from SHIP benefits side.
•Provides information on plan options, policy features, enrollment and other plan requirements. In particular, may help students who have graduated or have to take a leave from campus who are struggling with insurance transitions to understand post-SHIP options and connect to (and even at times enroll in ) insurance resources.
•Other duties as assigned. Prioritizes work assignments, conducts analysis and develops resulting recommendations.
•Conducts trend and other analyses to ensure SHIP patients are getting receiving the benefits they need, that they understand their plan and how it works, and that the referral process is working as intended. Recommends changes or improvements to the Associate Director for Insurance and the UHS Care Management Team. May maintain and update preferred provider network databases.•Minimum of 2-3 years of insurance experience preferably in student health insurance and/or experience in care coordination. •Possesses analytical skills to conduct analysis and develop recommendations, demonstrating organization and problem-solving skills. •Organization and problem-solving skills. •Knowledge of functional area and understands how work may impact other areas. •Demonstrates skill in conducting limited analysis and in writing and speaking clearly and effectively in order to provide information and some interpretation of programs to managers and employees. •Demonstrated strong verbal communication skills. •Demonstrated ability to collaborate and communicate effectively in a team setting. •Ability to maintain effective and professional relationships with patient and other members of the care team. •Must be computer literate; skills must support medical applications (for example, electronic medical records & retrieval, appointment scheduling programs, tracking and screening programs). •Experience in utilizing data to inform decision-making. •Ability to perform job duties in sometimes ambiguous situations requiring flexibility and willingness. •Interest in continuing development of this new role.
Education/Training: •Bachelors degree in related area and/or equivalent experience/training. •Minimum of two years of experience in insurance or care coordination. Employment is contingent on successful completion of: Background Check, Acceptable Medical Evaluation that includes infectious disease surveillance and proof of current required vaccinations or immunity levels, and successful credentials verification (if applicable).
The University of California was chartered in 1868 and its flagship campus - envisioned as a "City of Learning" - was established at Berkeley, on San Francisco Bay. Today the world's premier public university and a wellspring of innovation, UC Berkeley occupies a 1,232 acre campus with a sylvan 178-acre central core. From this home its academic community makes key contributions to the economic and social well-being of the Bay Area, California, and the nation.