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Job Details


CVS Health

Member Advocate - Work from Home - Pennsylvania (2086676BR)

Pharmaceuticals

All

Yearly

No

Cranberry Township, Pennsylvania, United States

Job Description
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

Position Summary/Mission:

The Member Advocate works alongside other DSNP care team members including social workers, care managers and care coordinators to provide the best member experience.

Fundamental Components

Educates and assists members on various elements of Medicaid benefits and services , benefit plan information and available services created to enhance the overall member experience with the company. Utilizes all relevant information to effectively influence member engagement.

Initiates contact with members who have lost their Medicaid eligibility and fall into the DSNP grace period, to remind them to follow through with their Medicaid and LIS recertification. Assists members with finding resources to help them reapply if necessary.

Coordinates and sends annual reminders for members at risk of losing LIS, Medicaid, or DSNP eligibility.

Takes ownership of each customer contact to anticipate customer needs, resolve their issues and connect them with additional services as appropriate.

Tracks member’s Medicaid certification and eligibility dates and MCO plan information, as well as Medicaid status.

Researches other general Medicaid programs, benefits and services the members are eligible for and initiate process to inform members of these benefits.

Completes accurate case documentation as needed.

Works with National DSNP Program Office Medicaid Policy Manager and State Contract Manager to provide general assistance with Medicaid benefits and entitlements.

Required Qualifications
Knowledge of Medicaid benefits, services, program and system design (Health and Welfare, Wealth, other benefits), legal/regulatory requirements.

Knowledge and understanding of state policy or Medicaid eligibility and low-income state resources.

Strong collaboration skills and innovative problem-solving abilities.

Strong verbal and written communication skills

Ability to work independently, accurately, and efficiently

Innovative Thinking and “Change Agent” - Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services.

Empathy towards customers’ needs and concerns.

COVID Requirements


COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
Please see requirements above

Education
Associate’s degree or equivalent work experience

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.