Member Advocate (Must reside in OK)

 

Business Overview:

Aetna Better Health of Oklahoma, a CVS Health company, embodies the vision to be a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way!

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Position Summary:
Qualified candidates must reside in Oklahoma. The Member Advocate is responsible for representation of Member’s interest, including input in policy development, planning and decision-making. The Member Advocate should have lived experience as a Member. The Member Advocate shall be responsible for development and oversight of the Advisory Committee.

The position is dedicated to work with the health plan’s members and providers to facilitate the provision of benefits. The Member Advocate is responsible for making recommendations to the management team regarding any changes needed to improve either the actual care provided or the manner in which the care is delivered. In state travel as required to fulfill duties.

Fundamental Components:

• Investigate and resolve access and cultural sensitivity issues identified by the health plan staff, State staff, providers, advocate organizations, and members.
• Monitor the health plan’s formal and informal grievances with the grievance personnel to look at trends or major areas of concern; discuss these reports with community advocates, if requested.
• Coordinate with schools, community agencies and State agencies providing services to members.
• Recommend policy and procedural changes to the health plan’s management including those needed to ensure/improve member access to care and quality of care; changes can be recommended for both internal administrative policies and provider requirements.
• Function as a primary contact for member advocacy groups; work with these groups to identify and correct member access barriers.
• Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of members.
• Analyze systems functions through meetings with staff.
• Organize and provide training and educational materials for the health plan’s staff and providers to enhance their understanding of the values and practices of all cultures with which the health plan interact.
• Provide input to management on how provider changes will affect member access and quality/continuity of care; develop/coordinate plans to minimize any potential problems
• Review all informing material to be distributed to members.
• Assist members and authorized representatives obtain medical records.
• Performs other related duties and special projects as assigned.
• Maintains availability/willingness to travel to various locations as frequently as necessary to meet business needs (if travel is required).
• Maintains availability and willingness to work the schedule necessary to meet business needs.
• Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
• Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
• Effective interpersonal skills and ability to act as a team player.
• Ability to pay attention to detail, work in a fast paced/evolving environment. Capable of meeting deadlines on a consistent basis.
• Ability to pay attention to detail, work in a fast paced/evolving environment. Capable of meeting deadlines on a consistent basis.
• Effective organizational skills and ability to manage multiple tasks.
• Ability to successfully interact with members, medical professionals and health plan and government representatives.

Pay Range
The typical pay range for this role is:
Minimum: 43,700
Maximum: 100,000

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit

jobs.CVSHealth.com/benefits

Required Qualifications

• Must reside in Oklahoma.
• 2+ years’ health care experience preferably working with low-income populations, and with demonstrated cultural sensitivity.
• Special events experience required.
• Effective telephonic skills and verbal, written, and presentation communication skills required.
• 2+ years of experience with personal computer, keyboard navigation, and MS Office Suite applications.
• Must possess reliable transportation and be willing and able to travel in-state up to 25%. Mileage is reimbursed per our company expense reimbursement policy.

Preferred Qualifications

• Lived experience as a member is highly desired.
• Bilingual speaking skills.
• Medicaid/insurance experience.
• Cultural Competency training experience.
• Claims processing experience helpful.
• CPT, ICD-9-CM, and HCPCS experience.
• Community relations experience.
• Experience managing appeal and grievances.
• Statistical analysis skills helpful.

Education

• High school diploma or equivalency.

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. 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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