Member Advocate - DSNP

Responsibilities

• Takes incoming calls on a direct or ACD line as per unit and job function.
• Performs outbound outreach, welcome, and gap closure calls to members.
• Conducts Health Risk Assessments on DSNP members telephonically or when appropriate in a face to face setting.
• Schedules member care team meetings and maintains agendas and minutes.
• Refers members to needed health services and facilitates access to or arranges community resources.
• Works with Nurse Navigators and Social Workers to coordinate care and services for members, may obtain consultations, reports or diagnostics from providers; files and notifies requesting staff of records.
• Facilitate or arrange transportation services or personal care services.
• Attends member care team meetings as needed.
• Makes sure to monitor for changes in member Medicaid eligibility requirements and assists members as needed.
• Helps to coordinate Medicare and Medicaid benefits.
• Has established adequate proficiency in using THP platforms/applications necessary to perform the functions of a Member Advocate, i.e. various programs & assessments in HEART and Case Tracker, Cave or other unit specific tools.
• Maintains monthly monitoring scores of >90% accuracy on unit Member Advocate interrater at and after 1 year of work.
• Demonstrates a complete understanding of departmental policies and procedures. Uses Policy Stat, Employee Manual and other reference tools as appropriate.
• Consistently displays positive/professional attitude and is compliant with attendance policies.
• Able to diffuse tense situations/angry members and resolve issues.
• Displays good time management and multitasking skills.

Requirements

• Required High School Diploma.
• Proficiency with basic computer use (Windows)/keyboarding and office equipment (fax, print, scan, Polycom phone).
• Knowledge of medical terminology.
• Experience gathering health information via telephonic outreach.

Desired

• Post high school course work in business, social services, health care, behavioral health, or health care administration is helpful.
• Undergraduate degree in health related field is preferred.
• Strong speaking, written, and analytical skills, motivation and initiative, and an ability to work independently.
• Proficiency in word processing programs (Microsoft Word and Excel) and other related PC usage.