Employer: CVS Health
This position also includes a $1,000 sign on bonus as well as an additional $2,000 to be paid out after 6 months! (Bonuses are only applicable to external candidates in specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting).
The Health Advocate within the Healthy Outcomes Team conducts outreaches to our Medicare members to inspire and encourage healthy behaviors through innovative, compassionate and empathetic telephonic communications. The goal of each outreach is to ensure that every member has a clear understanding of the available benefits that are afforded to them under their Medicare plan for specific screenings. The Health Advocate facilitates Provider and Member outreaches telephonically to ensure Medicare member receipt of important services to improve Star health outcomes.
The Health Advocate provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives by performing the following:
- Outreach to members who don t have a record of the designated services, vaccination, or medication refill.
- Effective capture of barriers and data collection, use of motivational interviewing skills to provide solutions to meet the gap in care, and providing best in class support to each member.
- Ensures that every customer is treated professionally, with respect and all questions are thoroughly answered and/or triaged and responded to.
- Acts as an advocate for our Medicare members preventive health and vaccination needs.
- Collect effective data elements in the CRM tool to support medical record chasing for HEDIS medical record documentation and services.
- Provides members with the right information at the right time to help them make better decisions about their health and health care, to increase member satisfaction, retention, and growth by efficiently delivering competitive services to members and providers through a fully integrated organization staffed by knowledgeable, customer-focused professionals supported by exemplary technologies and processes.
- Engages, consults, and educates members based upon the member s unique needs, preferences and understanding of the services.
- Provides end to end accountability for the member.
- Answers questions and resolves issues as a “single-point-of-contact”
- Builds a trusting relationship with the member by taking accountability to fully understand the member s needs.
- Walk members through programs, Aetna tools and resources to support better health care consumer behaviors.
- Takes ownership of each member contact to resolve their issues and connect them with additional services as appropriate.
- Documents and tracks all member contacts, events, and outcomes via appropriate systems and processes.
- Uses communication skills to build relationships with both internal and external members/constituents.
- Uses applicable system tools and resources to produce and/or quality letters and spreadsheets in response to inquiries received.
- Handle multiple functions and/or multiple products while maintaining and/or exceeding performance standards.
- Identifies issues that need to be escalated appropriately and offers suggestions for resolution.
- Demonstrates professionalism and presents a positive image of the company when interacting with members and constituents.
- Supports individual, team and business goals and initiatives accepts ownership for individual results.
Required Qualifications
- Windows based application knowledge with ability to use standard corporate software packages and corporate applications with a high degree of computer literacy.
- Effective communication skills and experience speaking with medical providers and/or clinical staff.
- Strong listening and interpersonal skills skilled at developing and maintaining effective working relationships.
- Strong analytical skills focusing on accuracy and attention to detail.
- Demonstrated ability to de-escalate situations.
- Demonstrated empathy, compassion and listening skills.
- Ability to apply creative thinking skills when needed to solve members’ concerns and have a desire to advocate for them.
- Ability to thrive on change, to adapt to multiple focuses in short amounts of time.
- Ability to work independently, apply critical thinking skills when needed, multitask with ease, and demonstrate professionalism in all interactions.
- Ability to resolve complex issues with sensitivity and discretion.
- Ability to creatively solve members problems and have desire to help and advocate for them.
- Ability to absorb and apply new and changing information.
- Ability to make effective and independent decisions
- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment
Location Specific: AR, NJ, IA, AL, FL, GA, KY, MO, MN, IL, NM, TX, KS, MS, CA, ID, UT, NV, AZ, OH