Regional Member Advocate & Care Coordinator

American Health Communities; Missouri; On-site; USD 42,000 - 62,000; Full time

Job summary

American Health Plans seeks a dedicated Member Advocate to support local service areas in Missouri. The role focuses on seamless enrollment transitions, ongoing member follow-up, and frontline support with members and facilities.

You will build relationships with nursing facilities and providers, ensure CMS compliance across interactions, and meet with members monthly to address needs and gather feedback for the plan. Local travel and strong communication are essential.

Qualifications

• Experience in healthcare delivery with elderly patients; nursing home experience preferred.
• Exceptional interpersonal skills; able to work independently and with a team.
• Ability to work well with nursing home staff, doctors and administration.
• Outstanding customer service track record.
• CMS regulations compliance for Medicare Advantage Plans.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure seamless transition.
• Follow up with member to answer questions and provide periodic updates about the plan.
• Act as frontline support with member, partner facility and care team to meet needs.
• Develop and maintain relationships with network providers in the assigned region.
• Meet with the member and/or family at least monthly.
• Follow up on items causing dissatisfaction and report to plan.
• Develop and maintain reporting on member status, facility calendars, issues tracking.
• Ensure all interactions comply with CMS regulations.
• Advocate for a group of nursing facilities to ensure services for all members.
• Other responsibilities as assigned.

Skills

Interpersonal skills

Independent work

Teamwork

Customer service

CMS regulations

Organizational skills

Communication

Travel readiness

Microsoft Office

Education

Associates or better

Tools

Microsoft Office Suite

Job description

American Health Plans seeks a dedicated Member Advocate to support local service areas in Missouri. The role focuses on seamless enrollment transitions, ongoing member follow-up, and frontline support with members and facilities.

You will build relationships with nursing facilities and providers, ensure CMS compliance across interactions, and meet with members monthly to address needs and gather feedback for the plan. Local travel and strong communication are essential.