SNP Engagement Specialist

🕒 Julho 11

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Peak Health

SiteLinkedInTodas as Vagas

51 - 200 funcionários

🏥 Saúde

💼 Consultoria

🛡️ Seguros

Healthcare • Consulting • Insurance

A Peak Health é uma seguradora de saúde e serviços de seguros de saúde com sede em Morgantown, West Virginia. É de propriedade de três prestadores de saúde sem fins lucrativos: WVU Health System, Marshall Health Network e Valley Health. A Peak Health tem como objetivo melhorar os resultados de saúde da comunidade oferecendo um plano de saúde inclusivo, liderado por fornecedores para os residentes da Virgínia Ocidental e áreas adjacentes. A empresa está comprometida em tornar os cuidados de saúde mais acessíveis, compreensíveis e colaborativos, com foco na redução de custos e taxas administrativas para pacientes e empregadores. A Peak Health também oferece cobertura do Medicare Advantage, adaptada para idosos da Virgínia Ocidental, por meio de parcerias com os principais sistemas de saúde.

Descrição

• Participate in activities related to care management program build, implementation, oversight, and delegation. • Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements. • Assists in the coordination of transitions of care in coordination with the Care Management clinical staff. • Supporting the CM in guiding members through Health Risk Assessment completion and document responses accurately in required systems. • Assist the members in coordination of services with guidance provided by the Care Management clinical staff. • Conducting timely follow-ups with the members and/or their designated caregivers post transition to ensure planned services have been provided as planned in coordination with the SNP CM and Medicaid coordinators. • Educate members on DSNP supplemental benefits (OTC, transportation, dental/vision/hearing, flex cards, etc.) and assist with access. • Facilitate scheduling of PCP visits, annual wellness visits, and preventive screenings. • Serves as a contact for the D-SNP members to coordinate CM engagement. • Assists members in the coordination of services when appropriate and under the guidance of CM. • Works closely with the CM and/or SW staff regarding socio-economic issues, such as needed community services or to assist in the establishment of appropriate access to care. • Generating and coordinating various members and provider written communications. • Documenting in the members’ case accurately and timely to ensure coordination of the members’ care needs. • Adhering to all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines as well as those outlined within the MOC. • Conduct outbound and inbound calls to DSNP members to welcome them to the plan, explain benefits, and encourage use of covered services. • Ensures Accuracy of data entry to prevent downstream errors. • Identifies and escalates urgent member needs when identified.

🎯 Requisitos

• High School diploma or equivalent. • One (1) year of working in a healthcare or managed care setting. • One (1) year of customer service experience. • Associate Degree in related healthcare field preferred. • Experience with Medicare, Medicaid or SNP populations preferred. • Demonstrated knowledge of CMS regulatory and contractual documents. • Knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning. • Excellent written and oral communication. • Problem solving capabilities to drive improved efficiencies and customer satisfaction. • Attention to detail. • Proficiency with Microsoft Office products. • Ability to work under stressful working conditions. • Meeting defined deadlines and deliverables is an imperative skill for this role. • Excellent interpersonal, analytical, computer, organizational, verbal and written communication skills essential. • Ability to identify problems and opportunities and communicate to management.

🏖️ Benefícios

• Standard office environment.