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Job Information

CVS Health DSNP Member Advocate - WAH in E Granby, Connecticut

Req ID: 72278BR

Job Description

This position will act as part of the dual eligible member's care team at the state level responsible for integrating and coordinating care to meet the uniquely complex healthcare needs of our DSNP members. This position will assist our dually eligible members with maintaining Medicaid and LIS eligibility and obtaining other Medicaid entitlements available to them. They will be responsible for monitoring member statuses and reporting results to management.

Fundamental Components included but are not limited to:

Work alongside other DSNP care team members including social workers, care managers and care coordinators to provide the be member experience by:

  • Educating and assisting members on various elements of Medicaid entitlements, benefit plan information and available services created to enhance the overall member experience with the company.

  • Utilize all relevant information to effectively influence member engagement.

  • Initiating contact with members who have lost Medicaid eligibility and fall into DSNP grace period to obtain Medicaid and LIS certification.

  • Assist members with finding resources to help them reapply if necessary.

  • Coordinating annual reminders for members at risk of losing LIS, Medicaid or DSNP eligibility.

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

  • Identifying member needs beyond the initial inquiry by answering the unasked questions and asking probing questions to identify member needs.

Other responsibilities include:

  • Track member s Medicaid certification and eligibility dates and MCO plan information, as well as Medicaid status.

  • Researching other Medicaid programs and entitlements the members are eligible for and initiate process to inform members of these benefits.

  • Complete accurate case documentation as needed.

  • Communicate cases to management where contact has not been achieved.

  • Other general outreach to members as needed.

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

Qualifications Requirements and Preferences:

  • Associates degree or equivalent work experience

  • Empathy towards customers needs and concerns, and proactively solicits and anticipates customer needs

  • In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other benefits), related financials, legal/regulatory requirements.

  • Demonstrated experience and knowledge in 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 maintain accuracy and production standards.

  • Ability to work independently.

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

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Customer Service

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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