Member Advocate Specialist, Dentaquest

2 weeks ago

Wellesley Hills, United States DentaQuest Full time

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.
- DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all._

**Must reside in Harris County, TX**

At Sun Life, we look for optimistic people who want to make life brighter for our Clients. We understand the value of diverse cultures, perspectives, and identities, and want you to bring your full and authentic self to work. Every day, you’ll be empowered and challenged by working with dynamic colleagues to find new and innovative ways to make Sun Life the best benefits company in America.

**The opportunity**:
The Member Advocate Specialist (MAS) has direct oversight for the advocacy of members included but not limited to preventive dental care, access to care, education, complaints and grievances, appeals, and dental home. In addition, attends virtual or in-person health fairs and community events, as directed by business need.

**How you will contribute**:

- Facilitate the delivery of preventive dental services for eligible members every six months beginning at six months of age.
- Including engagement of members via telephone to support outreach business objectives. Facilitate the delivery of preventive dental services for new members within 90 days of enrollment.
- Collaborate with other advocate specialists, Outreach Coordinators, and marketing department in the development of generic and customized outreach strategies for increasing dental access rates.
- Coordinate with community engagement of health plan and clients via virtual or in-person opportunities.
- Collect, compile and analyze information gleaned from virtual or in-person outreach initiatives/events in order to determine impact, and recommend changes that may make future outreach projects more effective.
- Establish and maintain community relationships that provide for participation in health care initiatives and programs to create dental awareness. These relationships will aid in the member advocate’s ability to refer members to community resources that can accommodate members’ needs if the services are not medically necessary covered dental services.
- Understand the cultural and socio-economic characteristics of their region(s).
- Assist members, either in person or via telephone, with writing complaints.
- Responsible for monitoring complaints through completion.
- Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner (within 30 days for routine care/within 28 days for routine care in NY).
- Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs.
- Facilitate and support the dental home process in their region.
- This includes tasks such as assisting members with finding a dental home, coordinate case management for various populations including special needs and Children of Migrant Farm Workers (TX only), maintaining the data for reporting dental home activities, and coordinating outreach efforts.
- Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination and case management performance measures to DentaQuest management.
- Identify disparities, opportunities for improvement and recommended solutions.
- Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP and Frew guidelines (for TX only).
- Adhere to DentaQuest business processes.
- Other duties as assigned.

**Member Advocate Specialist TX**
- Collaborate with DentaQuest management, internal departments, state & local agencies and HHSC clients to plan, evaluate and implement activities to improve access and appropriate care to members.
- This includes making recommendations on changes that may improve either the care provided, or the way care is delivered.
- Ensure members receive educational materials upon enrollment regarding the services available through the Texas Health Steps program and how to obtain them.
- Educational material also includes information on:

- Member’s rights and responsibilities
- The complaint processes
- The appeal processes
- Medically necess

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