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 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.
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-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
- If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
- If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.
Please see requirements above
Associate's degree or equivalent work experience
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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