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Careers


Member Advocate/Member Rights Specialist

    • Job Tracking ID: 512689-597751
    • Job Location:  Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: November 09, 2017
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

This position provides assistance and support to iCare members, staff, and providers to facilitate the provision of appropriate benefits for iCare members and evaluate and make recommendations regarding changes needed to improve care or its delivery. This position is also responsible for developing, implementing and evaluating outreach programs to promote positive health management and access to preventive services for the Independent Care members who are at high risk for low health literacy or culturally-sensitive needs.

  1. Advocates for members to ensure that appropriate medical, social and community services are being provided and resolve any issues related to access of these services.

  2. Monitors formal and informal grievances in cooperation with Quality Improvement personnel for the purposes of identifying trends related to access, care delivery, and/or cultural sensitivity. This includes ongoing participation in the grievance committee.

  3. Collaborates with Quality Improvement personnel and Care Management staff in the resolution of member complaints and grievances.

  4. Coordinates the development and evaluation of member outcomes for preventive and health education outreach programs.

  5. Participates in public forums and special events to educate iCare members and the public on issues pertaining to membership and enrollment in iCare.

  6. Functions as the primary contact for local community-based organizations to acquire knowledge and insight regarding the special health care needs of Independent Care Health Plan enrollees.

  7. Participates in external workgroups, coalitions, and committees.

  8. Organizes and provides ongoing training and educational materials for staff and providers to enhance their understanding of the values and practices of all cultures with which the MCO interacts.

  9. Reviews all informing material to be distributed to iCare Health Plan enrollees for the purpose of assessing clarity and accuracy.

  10. Assists members and their authorized representatives for the purpose of obtaining medical records.

  11. Provides ongoing input to MCO management on how changes in the MCO provider network may affect member access to quality care and to recommend policy and procedural changes needed to ensure and/or improve member access to and quality of care.

  12. Provides input to MCO management as it pertains to ongoing analysis of internal HMO functions related to member access to medical care and the quality of care provided.

  13. Develops a Member Advocate work plan and monitors compliance with the stated goals.

  14. Fulfills Limited English Proficiency coordination role for the Health Plan.

     

Experience and Skills:

  1. Bachelor’s degree in sociology or related field.

  2. Strong interpersonal skills and ability to work effectively with persons with disabilities, as well as a wide diversity of ethnic, cultural and socioeconomic backgrounds.

  3. Ability to develop and maintain effective working relationships with providers, other agencies and organizations.

  4. Ability to deliver effective presentations to small and large groups.

  5. Prior work experience interacting with members who have physical, developmental or chronic mental illness.

  6. General knowledge of Medicaid , Medicare, and Long-Term Care benefits.

  7. Knowledgeable and experience working with disabled persons

  8. Ability to use sound judgment in providing quality customer service to members and providers.


 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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