Regional Member Care Advocate

American Health Plans; Ashland (KY); On-site; USD 42,000 - 62,000; Full time

Job summary

American Health Advantage is seeking a customer-service focused leader to support local service areas. You will coordinate enrollment transitions, follow up with members, and serve as a primary contact for members and facilities within your region.

Responsibilities include relationship-building with providers, monthly member meetings, and ensuring CMS compliance across interactions. Travel to facilities within the assigned region is required; nursing home experience is preferred.

Qualifications

• Experience in healthcare delivery with elderly patients; clinician, social worker, or caregiver background preferred.
• Nursing home exposure is preferred.
• Strong interpersonal skills and ability to work independently or with a team.

Responsibilities

• Coordinate with Insurance Producer after enrollment to ensure smooth transition and service success.
• Follow up with members to answer questions and provide plan-related assistance.
• Act as frontline contact for members, facilities, and care team to meet member needs.
• Develop and maintain relationships with network providers/facilities in the region to meet network adequacy.
• Meet with members/families at least monthly.
• Document and report any member dissatisfaction to the plan.
• Maintain reporting on member status, facility calendars, and issue tracking.
• Ensure all interactions comply with CMS regulations.
• Oversee a group of nursing facilities to ensure services are carried out for all assigned members.
• Other duties as assigned.

Skills

Interpersonal skills

Customer service

Communication

Team collaboration

Attention to detail

Active listening

Travel readiness

Education

Associates or better

Tools

Microsoft Office

Job description

American Health Advantage is seeking a customer-service focused leader to support local service areas. You will coordinate enrollment transitions, follow up with members, and serve as a primary contact for members and facilities within your region.

Responsibilities include relationship-building with providers, monthly member meetings, and ensuring CMS compliance across interactions. Travel to facilities within the assigned region is required; nursing home experience is preferred.