Senior Policy Advocate

American Health Plans; Omaha (NE); Sur place; USD 50 000 - 70 000; Plein temps

Résumé du poste

American Health Advantage seeks a patient-focused leader to support local service areas. You will coordinate with the Insurance Producer after enrollment to ensure a seamless transition and follow up with members to answer questions about their plan.

You will act as frontline support for members, providers, and care teams, while developing regional provider relationships and monthly member meetings. Travel to facilities is expected.

Qualifications

• Experience in healthcare delivery settings with elderly patients preferred.
• Ability to work independently and as part of a team.
• Strong written and verbal communication, and organizational skills.
• Knowledge of CMS regulations and Medicare Advantage Plans is a plus.

Responsabilités

• Coordinate with Insurance Producer after enrollment to ensure smooth transitions.
• Follow up with members to answer questions and provide plan updates.
• Serve as frontline support for members, facilities, and care teams.
• Develop and maintain relationships with network providers within region.
• Meet with members or families monthly and document activities.
• Report dissatisfaction issues to the plan and track resolutions.
• Maintain reporting on member status and facility calendars.
• Ensure all member interactions comply with CMS regulations.

Connaissances

Interpersonal skills

Independent work

Team collaboration

Excellent communication

Computer skills

Formation

Associates or better

Outils

Microsoft Office Suite

Description du poste

Job Description

American Health Advantage needs a customer-service focused leader to support local service areas.

Responsibilities

• After member is enrolled, coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service success is achieved.
• Once member is enrolled, follow up member to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updates about the plan;
• Act as front-line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met;
• Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements;
• Meet with the member and/or their family at least monthly;
• Follow up on any items that the members are dissatisfied with and report to plan accordingly;
• Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management ;
• Ensure that ALL interactions with the member are compliant with CMS regulations;
• The Member Advocate will be responsible for a group of nursing facilities; the Member Advocate is responsible for ensuring that the above services are carried out for each of the members in your assigned group of facilities;

Other Responsibilities As Assigned. Qualifications/ Requirements

• Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred.
• Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the family;
• Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff;
• Ability to deliver outstanding customer service with a proven track record;
• Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans
• Exceptional organizational skills
• Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages
• Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver's license, a clean driving record, and proof of insurance;
• Strong proficiency in computer skills in Microsoft Office Suite products;
• Have suitable home work space allowing for productive office environment.
• Insurance or Insurance Customer Service License is preferred; however, not required.

Education Preferred

• ~ Associates or better

Licenses & Certifications Required

• Automobile Insurance
• Driver License

Equal Opportunity Employer

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