SNP Engagement Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Engage in activities related to the establishment, execution, management, and delegation of care management programs.

• Assist in ensuring adherence to CMS SNP Model of Care (MOC) expectations, NCQA standards, and Medicare Advantage regulatory obligations.

• Aid in coordinating transitions of care in collaboration with the Care Management clinical team.

• Support the Care Manager in guiding members through the completion of Health Risk Assessments and accurately document their responses in the required systems.

• Help members coordinate services with direction from the Care Management clinical staff.

• Perform timely follow-ups with members and/or their designated caregivers following transitions to confirm that planned services have been delivered as intended in coordination with the SNP Care Manager and Medicaid coordinators.

• Educate members about DSNP supplemental benefits (OTC, transportation, dental/vision/hearing, flex cards, etc.) and assist them in accessing these benefits.

• Facilitate the scheduling of PCP visits, annual wellness check-ups, and preventive screenings.

• Act as a liaison for D-SNP members to coordinate Care Management engagement.

• Assist members in service coordination when necessary, following guidance from the Care Manager.

• Collaborate closely with Care Managers and/or Social Work staff on socio-economic issues, including the need for community services or assisting in establishing suitable access to care.

• Generate and coordinate various written communications for members and providers.

• Accurately and promptly document in members’ cases to ensure the coordination of their care needs.

• Comply with all CMS, Code of Federal Regulations, local/state/national regulatory requirements and guidelines, as well as those specified within the MOC.

• Conduct both outbound and inbound calls to DSNP members to welcome them to the plan, explain benefits, and promote the utilization of covered services.

• Ensure data entry accuracy to avoid downstream errors.

• Identify and escalate urgent member needs when recognized.

⛳️ Requirements

• High School diploma or equivalent qualification.

• A minimum of one (1) year of experience in a healthcare or managed care environment.

• At least one (1) year of customer service experience.

• An Associate Degree in a related healthcare field is preferred.

• Experience with Medicare, Medicaid, or SNP populations is preferred.

• Demonstrated understanding of CMS regulatory and contractual documents.

• Familiarity with Medicare Advantage, NCQA accreditation standards, disease management, utilization management, care management, and discharge planning.

• Exceptional written and verbal communication skills.

• Strong problem-solving abilities to enhance efficiencies and customer satisfaction.

• Keen attention to detail.

• Proficient in Microsoft Office applications.

• Capability to work under demanding conditions.

• Meeting established deadlines and deliverables is crucial for this position.

• Excellent interpersonal, analytical, organizational, verbal, and written communication skills are essential.

• Ability to identify issues and opportunities and communicate them to management.

🏝️ Benefits

• Standard office environment.