Member Advocate

Responsibilities

• Coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service.
• Follow up member to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updates about the plan.
• Act as front-line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met.
• Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements.
• Meet with the member and/or their family at least monthly.
• Follow up on any items that the members are dissatisfied with and report to plan accordingly.
• Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management.
• Ensure that ALL interactions with the member are compliant with CMS regulations.
• Carry out the above services for each of the members in your assigned group of facilities.
• Other responsibilities as assigned.

Qualifications/Requirements

• Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred.
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family.
• Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff.
• Ability to deliver outstanding customer service with a proven track record.
• Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans
• Exceptional organizational skills
• Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages
• Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance
• Strong proficiency in computer skills in Microsoft Office Suite products
• Have suitable home work space allowing for productive office environment.
• Insurance or Insurance Customer Service License is preferred; however, not required.