Member Advocate - DSNP

The Health Plan (THP); Wheeling (WV); On-site; USD 35,000 - 45,000; Full time

Job summary

The Health Plan (THP) is seeking a DSNP Member Advocate to coordinate administrative functions within the DSNP Program, including Health Risk Assessments, scheduling care team meetings, and outreach. You will work with Nurse Navigators and Social Workers to coordinate care and ensure access to needed services.

Requirements include a high school diploma, basic computer proficiency, knowledge of medical terminology, and telephonic outreach experience.

Qualifications

• High School Diploma is required.
• Proficiency with Windows and general computer tasks is required.
• Knowledge of medical terminology is required.
• Experience gathering health information via telephonic outreach is required.
• Post-secondary coursework in business or health care is helpful; undergraduate degree preferred.
• Strong speaking and written communication, analytical skills, motivation and initiative, and ability to work independently are desired.
• Proficiency with Word and Excel is desirable.

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 in person when appropriate.
• Schedule member care team meetings and maintain agendas and minutes.
• Refer members to needed health services and facilitate access to resources.
• Coordinate with Nurse Navigators and Social Workers to arrange care and obtain reports/diags.
• Arrange transportation or personal care services as needed.
• Attend member care team meetings as required.
• Monitor Medicaid eligibility changes and assist members accordingly.
• Coordinate Medicare and Medicaid benefits.
• Use THP platforms/applications (HEART, Case Tracker, Cave) proficiently.
• Maintain monthly monitoring scores for accuracy after year one.

Skills

Medical terminology

Phone outreach

Computer skills

Communication skills

Analytical skills

Independent work

Education

High School Diploma

Post-secondary coursework

Undergraduate degree preferred

Tools

HEART

Case Tracker

Cave

Job description

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.

Required

• 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.

Desired

• Post high school course work in business, social services, health care, behavioral health, or health care administration is helpful. Undergraduate degree in health related field is preferred.
• Should possess strong speaking, written, and analytical skills, motivation and initiative, and an ability to work independently.
• Proficiency in word processing programs (Microsoft Word and Excel) and other related PC usage.

Responsbilities

• Take incoming calls on a direct or ACD line as per unit and job function.
• Performs outbound outreach, welcome, and gap closure calls to members.
• Conducts Health Risk Assessments on DSNP members telephonically or when appropriate in a face to face setting.
• Schedules member care team meetings and maintains agendas and minutes.
• Refers members to needed health services and facilitates access to or arrange community resources.
• Works 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.
• Attends member care team meetings as needed.
• Monitors for changes in member Medicaid eligibility requirements and assists members as needed.
• Helps to coordinate Medicare and Medicaid benefits.
• Has 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.
• Maintains monthly monitoring scores of >90% accuracy on unit Member Advocate interrater at and after 1 year of work.
• Demonstrates a complete understanding of departmental policies and procedures. Uses Policy Stat, Employee Manual and other reference tools as appropriate.
• Consistently displays positive/professional attitude and is compliant with attendance policies.
• Able to diffuse tense situations/angry members and resolve issues.
• Displays good time management and multitasking skills.

8:00am - 5:00pm