Medicaid Member Advocate

* Work with members, providers and the member’s case manager/care coordinator as needed to assist the member in obtaining care, including scheduling appointments and advising, enrolling in and accessing benefits.
* Investigate and resolve access and cultural sensitivity issues identified by HHO staff, State staff, providers, advocate organizations or members.
* Recommend policy and procedural changes to HHO management including those needed to ensure/improve member access to care and quality of care (changes can be recommended for both internal administrative policies and provider requirements).
* Conduct ongoing analysis of internal health plan system functions through meetings with health plan staff, to affect access to medical care and quality of medical care.
* Provide input to HHO management on how provider network changes will affect member access and quality/continuity of care and develop/coordinate plans to minimize any potential problems.
* Monitor and manage referrals to the Member Advocate team (phone, voice mail, web portal and department email).
* Function as a primary contact for member advocacy groups, human services agencies and the State entities, and work with these groups to identify and correct member access barriers.
Connect members with community-based organizations.
* Takes ownership of each customer contact to anticipate customer needs, resolve their issues and connect them with additional services as appropriate.
* Assist members and authorized representatives to obtain Personal Health Information (PHI) and medical records.
* Maintain full and complete records of all activities performed on behalf of a member.
* Assist with necessary resources for members for whom English is not their primary language or who communicate non-verbally.
* Escalate member issues up the chain of command to meet the health and safety needs of the member.
* Maintain a member advisory committee as required in the State’s Quality Management Strategy.
* Develop, plan and coordinate the health plan’s (MAC meetings; holding meetings at a regular cadence where the content meets member and health plan needs and DMMA requirements).
* Develop and implement strategies to increase member attendance, participation and engagement in MAC meetings.
* Research, interpret and respond to inquiries from members concerning health plan benefits and services.
* Resolve customer inquiries in an accurate, organized, efficient, and expert manner.

- Member Education  
* Collaborate with the Clinical Services and Quality department to coordinate the needs assessment and action plan for addressing the education needs of health plan members.  
* Encourage all member population and community participation in the health plan’s Health Awareness Series (HAS).  
* Educate and assist members with various elements of Medicaid entitlements, benefit plan information and available services created to enhance the overall member experience with the health plan.  
* Organize and provide training and educational materials for HHO staff and providers to enhance their understanding of the values and practices of all cultures with which the health plan interacts.  
* Review and recommend all health plan informational materials to be distributed to Medicaid enrollees for the purpose of assessing clarity and accuracy.  
* Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of Members and update and revise educational materials as appropriate.  
* Guide members through the health care continuum, making them stakeholders in their own health through the use of self-management tools.  
* Educate the member regarding the availability and assist in accessing health and wellness programs and the various health promotion incentive programs offered by the health plan.
* Coordinate with schools, community agencies and State agencies providing services to members.
* Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of members to share with all internal stakeholders for analysis, decision-making and action planning accordingly.

- Member…