Member Advocate - DSNP at The Health Plan of West Virginia Inc

Wheeling, West Virginia, United States -

Full Time

Start Date

Immediate

Expiry Date

08 Oct, 26

Salary

0.0

Posted On

10 Jul, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Health Risk Assessments, Medical Terminology, Telephonic Outreach, Care Coordination, Case Management, Microsoft Word, Microsoft Excel, Conflict Resolution, Time Management, Multitasking, Administrative Coordination, Member Education

Industry

Insurance

Description

Under the general direction of the DSNP Supervisor, the DSNP Member Advocate is responsible for coordinating administrative functions within the DSNP 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: 1. High School Diploma. 2. Proficiency with basic computer use (Windows)/keyboarding and office equipment (fax, print, scan, Polycom phone). 3. Knowledge of medical terminology. 4. Experience gathering health information via telephonic outreach. Desired: 1. 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. 2. Should possess strong speaking, written, and analytical skills, motivation and initiative, and an ability to work independently. 3. Proficiency in word processing programs (Microsoft Word and Excel) and other related PC usage. Responsbilities: 1. Take incomming calls on a direct or ACD line as per unit and job function. 2. Performs outbound outreach, welcome, and gap closure calls to members. 3. Conducts Health Risk Assessments on DSNP members telephonically or when appropriate in a face to face setting. 4. Schedules member care team meetings and maintains agendas and minutes. 5. Refers members to needed health services and facilitates access to or arrange community resources. 6. 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. 7. Facilitate or arrange transportation services or personal care services. 8. Attends member care team meetings as needed. 9. Monitors for changes in member Medicaid eligibility requirements and assists members as needed. 10. Helps to coordinate Medicare and Medicaid benefits. 11. 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. 12. Maintains monthly monitoring scores of >90% accuracy on unit Member Advocate interrater at and after 1 year of work. 13. Demonstrates a complete understanding of departmental policies and procedures. Uses Policy Stat, Employee Manual and other reference tools as appropriate. 14. Consistently displays positive/professional attitude and is compliant with attendance policies. 15. Able to diffuse tense situations/angry members and resolve issues. 16. Displays good time management and multitasking skills. 8:00am - 5:00pm 40

Responsibilities

The Member Advocate coordinates administrative functions for the DSNP program, including conducting Health Risk Assessments and scheduling care team meetings. They are responsible for member outreach, gap closure calls, and facilitating access to community health resources.