Sr. Health Plan Promoter

Overview

U NITE HERE HEALTH serves 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

This is a Culinary Health Fund role

• The Sr Health Promoter is the face of the Fund, especially to participants, and to provide benefits, claims, eligibility, enrollment planning and support, and health care education and information to this multi-cultural community.
• This position will also be responsible for maintaining various spreadsheets, assisting with member inquiries, data entry and coordinating with Fund vendors on special projects.
• The ideal candidate will be based in Las Vegas. This is a field-based role requiring approximately 75%–100% travel within the assigned region. We are open to hiring candidates located in Sacramento, Biloxi, Atlantic City, and New York.
• Engages, educates, and motivates participants regarding participation in Fund programs/care coordination designed to improve health outcomes
• Recruits participants into Fund self-management programs; follows up with participants to ensure maximum participation; and establishes regular meetings for program graduates
• Coordinates with contracted Case Management partners, providers, vendors, and community resources to ensure access to quality care and appropriate services are available
• Collaborate with providers of care to retrieve medical records, such as inpatient clinical, emergency room records, discharge instructions and outpatient office visits along with member/member representative interviews to assist clinical care management partners to develop a comprehensive plan of care
• Meets with participants at their worksite, home, union office, and places where they receive medical services
• Reviews data to determine priority targets for program outreach
• Arranges, coordinates, and facilitates group programs, participant leader meetings and other health education events
• Recruit and develop participant leaders to expand the reach of these programs
• Plans calendar and priorities of health promotion work, in conjunction with Supervisor
• Documents outreach and engagement outcomes with members/member representatives, providers of care, community representatives and care management partners in documentation system (Sales Force/Car Ma) as applicable
• Provides input to management regarding concerns identified through interactions with participants
• Acts as the positive “face” of the Fund as the main point of contact for the Hospitality participants, unions, employers, providers, and vendors
• Provides benefit plan and eligibility information to participants, providers, unions, employers, and others for Hospitality plans
• Performs telephonic or onsite enrollment functions and in-person outreach as needed, including hosting, and attending enrollment events
• Provides proactive education to participants by phone, in person at the office, and at the worksite, including presentations and work with the union and employers to build a relationship and support these initiatives
• Receives and records telephone and walk-in inquiries regarding plan benefits
• Conduct root cause analysis on walk-in inquiries and provide management with recommendations on how to improve the member experience
• Maintains up-to-date knowledge of all systems and sources relating to plan benefits, processes, policies, etc. that will affect the performance of daily tasks
• Support the tracking and reporting of all inquiries, complaints, access issues, and requests received, including trending, root cause analysis, process improvements, and pending items to leadership regularly
• Utilizes internal system to record all activity, including updates and resolution details for all inquiries, complaints, and requests
• Participates in TPA Customer Service oversight meetings and analytics review
• Seeking management assistance on issues unable to resolve in a timely manner
• Maintains awareness of work volumes and service…