Helping you reach new heights
SNP Engagement Specialist
Location
United States
Posted
2 days ago
Salary
0
Seniority
Junior
Job Description
SNP Engagement Specialist
Peak Health
• Participate in activities related to care management program build, implementation, oversight, and delegation. • Assist in ensuring compliance with CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory requirements. • Assists in the coordination of transitions of care in coordination with the Care Management clinical staff. • Supporting the CM in guiding members through Health Risk Assessment completion and document responses accurately in required systems. • Assist the members in coordination of services with guidance provided by the Care Management clinical staff. • Conducting timely follow-ups with the members and/or their designated caregivers post transition to ensure planned services have been provided as planned in coordination with the SNP CM and Medicaid coordinators. • Educate members on DSNP supplemental benefits (OTC, transportation, dental/vision/hearing, flex cards, etc.) and assist with access. • Facilitate scheduling of PCP visits, annual wellness visits, and preventive screenings. • Serves as a contact for the D-SNP members to coordinate CM engagement. • Assists members in the coordination of services when appropriate and under the guidance of CM. • Works closely with the CM and/or SW staff regarding socio-economic issues, such as needed community services or to assist in the establishment of appropriate access to care. • Generating and coordinating various members and provider written communications. • Documenting in the members’ case accurately and timely to ensure coordination of the members’ care needs. • Adhering to all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines as well as those outlined within the MOC. • Conduct outbound and inbound calls to DSNP members to welcome them to the plan, explain benefits, and encourage use of covered services. • Ensures Accuracy of data entry to prevent downstream errors. • Identifies and escalates urgent member needs when identified.
Job Requirements
- High School diploma or equivalent.
- One (1) year of working in a healthcare or managed care setting.
- One (1) year of customer service experience.
- Associate Degree in related healthcare field preferred.
- Experience with Medicare, Medicaid or SNP populations preferred.
- Demonstrated knowledge of CMS regulatory and contractual documents.
- Knowledge of Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management and discharge planning.
- Excellent written and oral communication.
- Problem solving capabilities to drive improved efficiencies and customer satisfaction.
- Attention to detail.
- Proficiency with Microsoft Office products.
- Ability to work under stressful working conditions.
- Meeting defined deadlines and deliverables is an imperative skill for this role.
- Excellent interpersonal, analytical, computer, organizational, verbal and written communication skills essential.
- Ability to identify problems and opportunities and communicate to management.
Benefits
- Standard office environment.
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