SNP Engagement Specialist

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Peak Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

⚕️ Healthcare Insurance

🤝 Non-profit

Healthcare Insurance • Non-profit

Peak Health is a health insurer and health insurance services company headquartered in Morgantown, West Virginia. It is owned by three not-for-profit health care providers: WVU Health System, Marshall Health Network, and Valley Health. Peak Health aims to improve community health outcomes by offering an inclusive, provider-led health plan for residents of West Virginia and surrounding areas. The company is committed to making health care more accessible, understandable, and collaborative, with a focus on reducing costs and administrative fees for patients and employers. Peak Health also offers Medicare Advantage coverage tailored for West Virginia seniors through partnerships with leading health systems.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• Standard office environment.