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After member is enrolled, coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service success is achieved.
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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;
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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;
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Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements;
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Meet with the member and/or their family at least monthly;
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Follow up on any items that the members are dissatisfied with and report to plan accordingly;
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Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management;
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Ensure that ALL interactions with the member are compliant with CMS regulations;
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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;
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Other responsibilities as assigned.
Qualifications/ Requirements
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Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred.
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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;
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Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff;
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Ability to deliver outstanding customer service with a proven track record;
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Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans
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Exceptional organizational skills
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Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages
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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;
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Strong proficiency in computer skills in Microsoft Office Suite products;
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Have suitable home work space allowing for productive office environment.
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Insurance or Insurance Customer Service License is preferred; however, not required.
