Senior Manager, Member Advocacy
5 days ago
- Responsible for managing day-to-day operations of the Member Advocacy and Appeals Department including the investigation and resolution of cases, compliance with required processes, tracking, reporting, notifications to members and providers of case decisions and determinations, and appropriate case closure for all HMSA lines of business. Interacts with corporate decision-makers (e.g., HMSA Board members, executive and senior vice presidents, and Medical Directors) and providers, intercedes on behalf of members while maintaining the integrity of health plan contracts.
- Directs the development and implementation of Member Advocacy and Appeals policies and procedures to create an effective and efficient operating environment for all HMSA lines of business. Monitors applicable regulations/mandates and identifies potential opportunities and risks. Oversees and directs the development of plans for complying with regulations/mandates and ensures compliance. Drives corporate-wide process improvements identified through members' issues.
- Translates HMSA's vision and mission statement into strategic, tactical, and operational plans for the MAA Department. Develops and maintains these plans to remain consistent with changes in any legislative and agency mandates and HMSA's business strategies and priorities.
- Develops, plans, and maintains the MAA department budget and financial plans based on operational forecasts. Responsible for all MAA department financial expenditures and the monitoring of actual costs related to the yearly budget.
- Assesses the adequacy and effectiveness of the department organizational structure, staffing, resources, technology, and processes and develops action plans for improvement, to include assignment of subject-matter experts in handling appeals for each HMSA line of business (i.e., QUEST Medicaid, Medicare Advantage, self-insured groups, fully insured plans, ACA plans, etc.). Identifies dependencies between the MAA department and other departments; reflects these dependencies in the policies, procedures, and department plans; and communicates any changes to operations to the appropriate parties.
- Manages the MAA department staff, including performance reviews (PMPs) and compensation adjustments, training, guidance, and personal development. Develops performance measurements and communicates expectations to staff. Responsible for hiring and, when necessary, adherence to HMSA processes for determination for dismissal, and assignment of staff to operational duties and project tasks, as necessary. Monitors staff and provide feedback for continual improvement. Responsible for salary changes and consideration, including any increases upon annual review and bonuses.
- Represents the MAA Department on various teams and work groups where appeals/grievances are related or affected, including on-site audits for CMS (for Medicare Advantage), HSAG (for QUEST Medicaid), and NCQA (all HMSA lines of business)
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Assists in special projects.
- Other
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Senior Manager, Patient Advocacy
2 days ago
Boston, MA, United States Taylor Strategy Partners Full timeDescription At Orphalan we identify, develop, and provide access to innovative treatments for patients with rare diseases to make a positive and meaningful difference in their lives. We work together by listening to patients and putting them first, enabling us to provide treatments and services that work for them. We strive to develop rare disease...
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Alexandria, VA, United States American Academy of Otolaryngology Full timeReporting Structure:The Senior Manager, Congressional and Political Advocacy, reports to the Director of Advocacy.QualificationsBachelors’ Degree required with 5 years of federal legislative, political affairs, and grassroots experience. Knowledge and understanding of the legislative process, lobbying, and political fundraising highly desirable. Capitol...
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Senior Director, Patient Advocacy
2 days ago
, MD, United States Autolus Ltd Full timeVacancy for Senior Director, Patient Advocacy Location: Remote Job Summary Job Title: Senior Director, Patient Advocacy Reports to: SVP, Medical Affairs Department: Corporate – Medical Affairs About Autolus Autolus is a clinical-stage biopharmaceutical company developing next-generation, programmed T cell therapies for the treatment of cancer. The...
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Advocacy Manager
4 weeks ago
Fort Lauderdale, FL, United States Alzheimer's Association Full timeDescriptionPosition Summary: The Florida Advocacy Manager serves as the principal staff for grassroots advocacy efforts in Florida and is responsible for grassroots engagement and volunteer recruitment in support of the Association's state and federal public policy priorities. The Advocacy Manager reports to VP Public Policy and represents the Alzheimer's...
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Advocacy Communications Manager
1 day ago
Washington, DC, United States National Restaurant Association Full timeThe National Restaurant Association and National Restaurant Association Educational Foundation are proud to be part of a highly respected industry, providing hospitality, opportunity, and quality of life. Much like the industry we represent, we have a dynamic, diverse, and inclusive culture, grounded in trust, hospitality, collaboration, and innovation....
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Senior Manager, Customer Advocacy
1 day ago
Boston, MA, United States Snyk Ltd. Full timeAs the Senior Manager, Customer Advocacy & Community, you will lead a team of three in continuing to develop and expand our customer advocacy and community initiatives. You'll have the opportunity to craft and implement strategic programs aimed at nurturing relationships with key customers, amplifying Snyk's thought leadership, and validating our platform....
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Alexandria, VA, United States United Way Worldwide Full timePOSITION SUMMARY : (Eligible for Hybrid/ 3 days in office - Alexandria, VA) The Senior Director of State Policy and Advocacy will be responsible for leading United Way Worldwide’s support of state-specific policy advocacy efforts and providing technical assistance and training to strengthen local United Ways in developing and implementing policy and...
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Washington, DC, United States Invenergy, LLC Full timeSenior Director, Transmission Policy Advocacy Invenergy drives innovation in energy. Powered by decades of entrepreneurial experience and unparalleled execution, we solve the energy challenges facing our customers and communities. We provide power generation and storage solutions at scale around the world to create a cleaner energy future. We develop. We...
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Government Policy and Advocacy Coordinator
5 days ago
Honolulu, HI, United States HMSA Full timeMonitor, track and analyze legislation introduced at the state level. Generate weekly Executive Summary Report of key legislation.Develop and distribute weekly updates to HMSA executive staff throughout the legislative session.Monitor legislative hearings and meetings as needed.Conduct legislative research and compile summary reports on state and national...
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CA, United States Earthjustice Full timeCompany Overview:EARTHJUSTICE is a non-profit organization dedicated to protecting the natural world and promoting environmental justice. Our mission is to use law and advocacy to protect the air, land, water, and wild places of our country.Job Title: Senior Clean Energy AttorneySalary: $179,000+ (dependent on location)Job Description:We are seeking an...
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Family Advocacy Specialist
2 days ago
Honolulu, HI, United States Air Force Institute of Technology Full timeThis vacancy is for a GS-0101-12, Family Advocacy Specialist located in the Department of Homeland Security, U.S. Coast Guard, BASE OPERATIONS DIVISION -LOG-3 Honolulu, Hawaii Basic Requirements: This position has a positive Education Requirement in addition to at least one year of Specialized Experience or substitution of education for experience or...
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State Advocacy Manager
2 weeks ago
Saint Paul, MN, United States AARP Full time*Overview*AARP is the nation's largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. With a nationwide presence, AARP strengthens communities and advocates for what matters most to the more than 100 million Americans 50-plus and their families: health and financial security, and personal...
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Director of Advocacy
2 days ago
Providence, RI, United States Save The Bay Full timeJob Description Director of Advocacy REPORTS TO: Executive Director POSITION DESCRIPTION: The Director of Advocacy is responsible for the development and management of Save The Bay’s advocacy priorities; environmental policy initiatives and campaigns; legislative agenda; as well as supervision of the organization’s Policy Team, which includes both the...
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Senior Director, Advocacy
1 day ago
Washington, DC, United States EPIP Full timeArabella Advisors helps foundations, philanthropists, and investors who are serious about impact achieve the greatest good with their resources. We work on issues ranging from the social and economic advancement of women and girls, and conservation of our climate and planet, to reducing poverty and inequity in the United States and around the world. Our...
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Vice President of Public Policy
4 weeks ago
Washington, DC, United States YWCA USA Full timeYWCA USA OverviewYWCA USA is a national organization on a mission to eliminate racism, empower women, and promote peace, justice, freedom, and dignity for all. One of the oldest and largest multicultural organizations promoting solutions to enhance the lives of women, girls, and families, YWCA USA has been at the forefront of the most critical social...
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Public Health Advocacy Specialist
7 days ago
Honolulu, Hawaii, United States Hawaii Medical Service Association Full timeJob Summary">This position plays a vital role in supporting the Hawaii Medical Service Association (HMSA) and the Hawaii Association of Health Plans (HAHP) in their mission to improve healthcare services.About Us">HMSA is a leading health insurance provider in Hawaii, dedicated to delivering quality care and service to its members. The HAHP serves as the...
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Senior Government Relations Manager
1 week ago
Honolulu, Hawaii, United States Kamehameha Schools Full timeKamehameha Schools is seeking a Senior Government Relations Manager to lead our government relations efforts and advance our strategic plan and vision.The ideal candidate will have extensive public policy experience, including legislative analysis and research, and excellent relationship-building skills. A legal background and/or Native Hawaiian cultural...
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Senior Communications Manager
1 day ago
, MA, United States Massachusetts Nonprofit Network Full timeSenior Communications Manager / Communications Manager We protect, restore, and enhance the Charles River and its watershed through science, advocacy, and the law. We develop science-based strategies to increase resilience, protect public health, and promote environmental equity as we confront a changing climate. Job Description Charles River Watershed...
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Advocacy and Communications Intern
2 weeks ago
South Richmond, VA, United States AARP Full time*Overview*AARP is the nation's largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. With a nationwide presence, AARP strengthens communities and advocates for what matters most to the more than 100 million Americans 50-plus and their families: health security, financial stability and...
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Advocacy Intern
2 weeks ago
Pasadena, CA, United States AARP Full time*Overview*AARP is the nation's largest nonprofit, nonpartisan organization dedicated to empowering people 50 and older to choose how they live as they age. With a nationwide presence, AARP strengthens communities and advocates for what matters most to the more than 100 million Americans 50-plus and their families: health and financial security, and personal...