Member Advocate & Care Coordination Lead

American Health Partners; New Orleans (LA); On-site; USD 55,000 - 75,000; Full time

Job summary

American Health Advantage seeks a customer-service focused leader to support local service areas. The role centers on coordinating enrollment transitions, guiding members and families through plan details, and serving as a primary liaison with nursing facilities and care teams.

Responsibilities include monthly member meetings, issue-resolution reporting, and ensuring CMS compliance across all interactions. Travel to facilities within the assigned region is required to maintain network adequacy

Qualifications

• Experience in a healthcare delivery setting with elderly patients is preferred.
• Exceptional interpersonal and communication skills; ability to work independently and in a team.
• CMS regulations regarding Medicare Advantage Plans familiarity is a plus.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition and successful service.
• Follow up with members after enrollment to answer questions and provide plan assistance.
• Serve as front-line support with members, facilities, and care team to meet member and plan needs.
• Develop and maintain relationships with regional network providers/facilities to meet network adequacy requirements.
• Meet with members or families at least monthly.
• Follow up on dissatisfaction items and report to plan.
• Maintain reporting on member status, facility calendars, and issue tracking.
• Ensure all member interactions comply with CMS regulations.
• Oversee services for a group of nursing facilities and ensure coverage for each member in the assigned facilities.
• Perform other duties as assigned.

Skills

Healthcare delivery experience

Interpersonal skills

Customer service excellence

CMS compliance knowledge

Communication skills

Team collaboration

Travel readiness

Microsoft Office proficiency

Tools

Microsoft Office Suite

Job description

American Health Advantage seeks a customer-service focused leader to support local service areas. The role centers on coordinating enrollment transitions, guiding members and families through plan details, and serving as a primary liaison with nursing facilities and care teams.

Responsibilities include monthly member meetings, issue-resolution reporting, and ensuring CMS compliance across all interactions. Travel to facilities within the assigned region is required to maintain network adequacy