- 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.
- 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.
- 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 D-SNP 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.
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Member Advocate - Wheeling, United States - The Health Plan of West Virginia Inc
Description
Job Description
Job DescriptionUnder the general direction of the D-SNP Unit Manager or Unit Supervisor, the D-SNP Member Advocate is responsible for coordinating administrative functions within the D-SNP 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:
Desired:
Responsibilities: