Member Advocate - DSNP

Health Plan; West Virginia; On-site; USD 38,000 - 54,000; Full time

Job summary

Health Plan in Wheeling, WV seeks a DSNP Member Advocate to coordinate administrative DSNP functions. You will administer health risk assessments, schedule care team meetings, and perform outreach and education to members.

Responsibilities include coordinating care with nurses and social workers, arranging transportation and services, and monitoring Medicaid/Medicare benefits. Strong communication and computer skills are essential.

Qualifications

• High School Diploma required.
• Basic computer and office equipment proficiency (Windows, fax, print, scan).
• Knowledge of medical terminology and health-related terminology.
• Experience gathering health information via telephonic outreach.
• Strong speaking, writing and analytical skills; self-motivated and independent.
• Proficiency in Word and Excel; able to navigate PC applications.

Responsibilities

• Handle incoming calls on assigned line(s) per unit function.
• Conduct outbound outreach, welcome calls and gap closure.
• Perform Health Risk Assessments for DSNP members (telephonic or in-person).
• Schedule and document care team meetings; prepare agendas/minutes.
• Refer members to health services and coordinate access to community resources.
• Coordinate with Nurse Navigators and Social Workers to arrange services.

Skills

Computer literacy

Medical terminology

Telephonic outreach

Verbal communication

Written communication

Analytical skills

MS Word / Excel

Independent work

Education

High School Diploma

Post-high-school coursework in business/healthcare

Undergraduate degree in health-related field (preferred)

Tools

THP platforms/applications

HEART

Case Tracker

Cave

Job description

Member Advocate - DSNP

Full Time Clerical Wheeling, WV, US

Under the general direction of the DSNP Supervisor, the DSNP Member Advocate is responsible for coordinating administrative functions within the DSNP Program which may include administering the Health Risk Assessments, scheduling care team meetings and completing meeting agendas and minutes, performing initial outreach and education.

Requirements

• High School Diploma.
• Proficiency with basic computer use (Windows)/keyboarding and office equipment (fax, print, scan, Polycom phone).
• Knowledge of medical terminology.
• Experience gathering health information via telephonic outreach.
• Post high school coursework in business, social services, health care, behavioral health, or health care administration is helpful. Undergraduate degree in health related field is preferred.
• Strong speaking, written, and analytical skills, motivation and initiative, and ability to work independently.
• Proficiency in word processing programs (Microsoft Word and Excel) and other related PC usage.

Responsibilities

• Take incoming calls on a direct or ACD line as per unit and job function.
• Perform outbound outreach, welcome, and gap closure calls to members.
• Conduct Health Risk Assessments on DSNP members telephonically or when appropriate in a face to face setting.
• Schedule member care team meetings and maintain agendas and minutes.
• Refer members to needed health services and facilitate access to or arrange community resources.
• Work with Nurse Navigators and Social Workers to coordinate care and services for members, may obtain consultations, reports or diagnostics from providers; files and notifies requesting staff of records.
• Facilitate or arrange transportation services or personal care services.
• Attend member care team meetings as needed.
• Monitor for changes in member Medicaid eligibility requirements and assist members as needed.
• Help coordinate Medicare and Medicaid benefits.
• Have established adequate proficiency in using THP platforms/applications necessary to perform the functions of a Member Advocate, i.e. various programs & assessments in HEART and Case Tracker, Cave or other unit specific tools.
• Maintain monthly monitoring scores of >90% accuracy on unit Member Advocate interrater at and after 1 year of work.
• Demonstrate a complete understanding of departmental policies and procedures. Use Policy Stat, Employee Manual and other reference tools as appropriate.
• Consistently display a positive/professional attitude and comply with attendance policies.
• Able to diffuse tense situations/angry members and resolve issues.
• Display good time management and multitasking skills.