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.
The Member Advocate works alongside other DSNP care team members including social workers, care managers and care coordinators to provide the best member experience.
- Educates and assists members on various elements of Medicaid entitlements, 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 Medicaid eligibility and fall into DSNP grace period to remind them to reobtain 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 and entitlements 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.
- In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other benefits), related financials, 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.
Education and Certification Requirements
- Associate's degree or equivalent work experience
Associate's degree or equivalent experience
Percent of Travel Required
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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