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TruHealth · 1 day ago

Member Advocate

Orlando, FL

Full-time

Hybrid

New Grad, Entry Level

TruHealth is a division of American Health Partners Inc. that operates Institutional Special Needs Plans for seniors in long-term care facilities. The Member Advocate role focuses on providing customer service support to members, ensuring their needs are met, and developing relationships with partner facilities in the assigned region.

Health CareHome Health CareRehabilitation

Responsibilities

Member Advocate will welcome all new members in accordance with established Plan processes

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

Member Advocates will annually sponsor or assist with no less than one group activity at each of their regional nursing facilities

Contact TruHealth staff or appointees at least monthly, but more often as appropriate, to discuss and ensure the needs of the Member and Plan are met

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

Other responsibilities as assigned

Qualification

Healthcare delivery experienceCMS regulations knowledgeCustomer service skillsMicrosoft Office proficiencyInterpersonal skillsOrganizational skillsListening skillsWritten communicationVerbal communicationTeamwork

Required

Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver

CMS regulations regarding Medicare Advantage Plans

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

Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans

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

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

Current Driver's License in applicable state