Member Advocate

3 weeks ago

Wheeling, United States West Virginia Employer Full time

Under the general direction of the Unit Manager or Unit Supervisor, the Clinical Services Member Advocate is responsible for completing outreach activities for member engagement into various programs as well as performing additional program, unit and interdepartmental support functions. The Member Advocate is responsible for coordinating administrative or simple clinical functions within a program or line of business which may include but are not limited to: performing Welcome Calls/describing routine benefits, completing Health Risk Screeners or Assessments telephonically (or data entering those returned by mail), assisting members with transportation and entering relevant claims, navigating low risk members to resolve benefit access to care issues or to improve health and Wellness outcomes, scheduling/participating in care team meetings and completing meeting agendas and minutes, generating clinical analytic documents and reports as directed and sending reviews to appropriate programs, requesting/receiving/filing/data entering clinical information such as labs and visit notes as directed, conducting mailings and assisting with phone coverage for the unit or nurse. REQUIRED:1. High school diploma required. 2. Proficiency with basic computer use (Windows)keyboarding and office equipment (fax, print, scan, Polycom phone) required. DESIRED: 1. Post high school coursework in business, social service, health care, behavioral health or health-care administration is helpful. Undergraduate degree in health related field or LPN is preferred. 2. Should possess strong speaking, written and analytical skills, motivation and initiative, and ability for self-directed work. 3. Proficiency in Microsoft Word, Excel and Visio desirable. RESPONSIBILITIES: 1. Take incoming calls on a direct or ACD line as per unit and job function. 2. Perform outbound outreach/welcome, gap closure calls, and health risk screener / assessment calls to members. 3. Navigate low risk members within scope of practice, refer to needed health services/community agencies internally and externally, and facilitate access to or arrange for community resources as appropriate. 4. Educate low risk members within scope of practice regard-ing routine health and wellness promotion and maintenance activities, including smoking cessation. Refers to internal and external programs as appropriate following HRA, low risk navigation or clinical analytic reports. 5. Establishes adequate proficiency in using THP platforms/applications necessary to perform the functions of a Member Advocate, i.e. various programs & assessments in the case management platform or other unit specific tools inclusive of manual mail procedure performance. 6. Maintain monthly monitoring scores of >90% accuracy on unit MA interrater at and after 1 year of work. 7. Demonstrate a complete understanding of Departmental policies and procedures. Use Policy Stat, Employee Manual and appropriate reference tools as appropriate. 8. Work with Nurse Navigators and Social Workers to coordinate care and service for members, may obtain consultations, reports or diagnostics from providers; files and notifies requesting staff of records received. 9. Facilitate or arrange transportation services or personal care services. Assist members with transportation benefit and enter relevant claims. 10. Consistently display positive/professional attitude and be compliant with attendance policies. 11. Able to diffuse tense situations /angry members and resolve issues. 12. Display basic understanding of contracts and benefits for programs and lines of business as evidenced by ability to take incoming calls from member and provider services lines to address basic calls related to claims, eligibility and benefits or direct them to appropriate resources. 13. Display a basic understanding of claims process and can identify errors and direct for correction. 14. Display good time management and multitasking skills. 15. 100% of regular tasks are dedicated to care coordination of THP members.

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