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Member Advocate

2 months ago

pittsburgh, United States American Health Plans Full time

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Idaho, Louisiana, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.


If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application


Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleDoc 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts with company match
  • Employee Referral Bonus Program

Position Summary:

The Member Advocate is a customer-service focused position that will support local service areas. This role reports to the Program Manager of their specific work region. The position is considered a work-from-home position as no formal office space/work location is provided; however, the Member Advocate will conduct a large portion of his/her work within partner nursing homes within a specific work region.


Essential Functions:

  • Member Advocate will welcome all new members in accordance with established Plan processes.
  • Once member is enrolled, 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.
  • Member Advocates will annually sponsor or assist with no less than one group activity at each of their regional nursing facilities.
  • Contact TruHealth staff or appointees at least monthly, but more often as appropriate, to discuss and ensure the needs of the Member and Plan are met.
  • 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.
  • Other responsibilities as assigned.


Required Work Experience:

  • Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred.
  • CMS regulations regarding Medicare Advantage Plans


Other Requirements:

  • 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.
  • Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans.
  • 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.
  • 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.


License/Certification/Education Required:

  • Current Driver's License in applicable state
  • Associate Degree preferred


EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.


This employer participates in E-Verify.