PruittHealth AllyAlign Member Advocate (Atlanta) in Atlanta, Georgia

Category : Corporate

Location/City : GA - Atlanta

Id : 22446

This position is with AllyAlign, a partner of PruittHealth.

Role Summary/Purpose

AllyAlign Health has partnered with several Nursing Home companies to form Institutional Special Needs Plans (I-SNPs), which are a form of Medicare Advantage Plans. In Georgia, PruittHealth is our partner, together forming PruittHealth Premier. As an I-SNP, we will be covering the medical costs of people who are eligible for Medicare and who reside in our partner nursing facilities. We have established the Member Advocate role to enroll members into our plan and to serve as a point of contact for the member and/or their families during their coverage period with the I-SNP.

  • Competitive Salary – commensurate with experience plus quarterly bonus if required goals are met;

  • Competitive Benefits Package – health/dental/vision insurance, 401K

  • Travel – required within region (frequent), statewide (infrequent), and corporate headquarters in Richmond, Va (infrequent)

Responsibilities

This position is considered a work-from-home position as no formal office space/work location is provided. The Member Advocate conducts the majority of their work within Partner nursing homes in the Member Advocate-specific work region.

The following defines the responsibilities of the Member Advocate in serving our members.

As a member is enrolling with the plan, serve as a licensed insurance agent to explain plan benefits, answer questions about the plan, and facilitate the member’s enrollment into the plan during the annual open enrollment period and through continuous enrollment efforts;

Develop and implement a comprehensive facility-specific marketing plan for each targeted Partner nursing home. As necessary, a Member Advocate will be expected to modify and enhance facility marketing plans based on achievement of enrollment goals

Organize in-service events to gain maximum exposure to residents and their responsible party/family. Prepare and deliver a formal presentation, approved by CMS, for those attending the in-service. In-service events will take place various times with some likely being scheduled on evenings and/or weekends.

Once enrolled, follow up with the member to ensure that any questions are answered, act as a point of contact if the member or their family needs assistance with the plan, or provide them with periodic updates about the plan;

Act as front line support as needed with the member, partner facility and integrated care team to ensure the needs of the Member and Plan are met.

Develop and maintain relationships with key network providers/facilities within assigned region; support continued regional network development activities necessary to meet network adequacy requirements;

Meet with the member and/or their family at least monthly;

Conduct quarterly customer service surveys with the member and/or their family; based on the results of the survey, follow up on any items that the members are dissatisfied with;

Develop and maintain reporting to include but not limited to managing member status, daily/weekly/monthly facility calendar, issues tracking/management

Ensure that ALL interactions with the member are compliant with CMS regulations

The Member Advocate will be responsible for a group of nursing facilities; the Member Advocate is responsible for ensuring that the above services are carried out for each of the members in your assigned group of facilities

Other responsibilities as assigned

Qualifications/Requirements

The following requirements must be met for a candidate to be hired into this position:

Currently hold a license to sell health insurance in Georgia and be in good standing with the licensing board; or, ability to pass the educational requirements and testing required to obtain the license in your state of residence. Reimbursement for licensing fee and up to $250 for exam preparation materials and fees;

Documented successful sales experience (healthcare market preferred but not required);

Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans

Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team; must be a good listener to understand feedback raised by the potential member/family;

Three or more years of experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver. Nursing home experience is preferred but not required;

Exceptional organizational skills;

Strong written and verbal communication and clear thinking skills with the ability to synthesize complex issues into simple messages;

Ability to work well with staff at each of the nursing homes in the assigned region to include program director, nursing staff, doctors and administration staff;

Ability to deliver outstanding customer service;

Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance;

Strong proficiency in computer skills in Microsoft Office Suite products;

Have suitable home workspace allowing for productive office environment.

Company Profile

AllyAlign Health is sparking significant reform in the $357 Billion US long term care healthcare eco-system by enabling innovative risk and payment models among payers, providers and consumers, transitioning from fee for service to value-based care.

AllyAlign features a unique partnership model with the long-term care provider community that revolutionizes the financial incentives and practice patterns that results in improved health outcomes. AllyAlign has successfully partnered with the long term care provider community to obtain approval for a long-term care provider sponsored Medicare Advantage Special Needs Plan in three states. Additionally, the AllyAlign model is live in multiple states that have fully transitioned their dual eligible population into third party managed care, and incorporates long term care operators with over 450 licensed Skilled Nursing Facilities in over fifteen states. The AllyAlign partnership model consists of aligned facility, physician and Nurse Practitioner Integrated Care Teams (ICTs) supported and powered by the industry’s most advanced and efficient care coordination and administrative services engine.