Member Advocate: Patient Care & Network Liaison

American Health Partners; Lubbock (TX); 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, coordinating with Insurance Producers after enrollment and ensuring a smooth transition for success. The role requires working with members and families, answering plan questions, and providing periodic updates about the plan.

You will act as front-line support with members, facilities and the care team, building provider relationships and ensuring CMS compliance.

Qualifications

• Experience in healthcare delivery with elderly patients in a clinical, social work or caregiver role.
• Strong interpersonal and communication skills with a customer-service mindset.
• Ability to travel to nursing facilities within the assigned region and coordinate with providers.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure a seamless transition and service success.
• Follow up with members to answer questions and assist with plan-related needs for the family.
• Serve as front-line support with members, facilities and care teams to meet member needs.
• Develop and maintain relationships with regional providers/facilities to meet network adequacy.
• Meet with members or families monthly and document status and issues.
• Ensure all interactions comply with CMS regulations and report issues as needed.
• Manage reporting on member status, facility calendars and issue tracking.
• Oversee services across a group of nursing facilities within the assigned region.
• Other duties as assigned.

Skills

Healthcare delivery

Interpersonal skills

Team collaboration

Customer service

Travel readiness

CMS regulations

Microsoft Office

Communication

Job description

American Health Advantage seeks a customer-service focused leader to support local service areas, coordinating with Insurance Producers after enrollment and ensuring a smooth transition for success. The role requires working with members and families, answering plan questions, and providing periodic updates about the plan.

You will act as front-line support with members, facilities and the care team, building provider relationships and ensuring CMS compliance.