Position Overview

The Member Advocate ensures the interests of the company's members are understood, promoted and addressed by the organization and the larger health care system. This position is responsible for developing opportunities for members voices to be heard and helping the company maintain its member-centric focus.

Duties and Responsibilities

Include, but are not limited to, the following:

• Identifies and responds to individual member issues and complaints, works collaboratively with staff at all levels of the organization and the State to resolve member problems
• Assists members in more effectively navigating both the health plan system and the larger health care system
• Tracks and reports on individual issues/complaints/concerns, looking for patterns (utilize Acuity, other reporting software)
• Facilitates meetings of Neighborhoods Member Advisory Committees
• Continually works to develop innovative models to solicit the voice of the member; is not content to do things the same old way
• Identifies patterns regarding organizational and systematic social/health care access issues and works with the health plans senior leadership and the State/CMS to develop solutions
• Participates on committees, work groups, and/or process improvement teams that improve patient/customer satisfaction including Member Satisfaction Workgroup
• Provides two trainings per year to all departments that touch members on the role of the Member Advocate for all lines
• Advocates for the "voice of the member" in Neighborhood planning, implementation and improvement activities
• Participates as the representative of Neighborhood in specified community meetings, sharing information with leadership for health care system improvement
• Attends community meetings and events to better understand member concerns
• Represents Neighborhood at community events, talking with existing and prospective members as part of Marketing efforts
• Keeps Senior Management and the Board of Directors informed of critical member issues and the needed improvements
• Other duties as assigned
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhoods Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications

Required:

• Bachelor's degree in social work or other health related field or equivalent education and relevant work experience, specifically ten (10) or more years of social service experience in lieu of a degree
• Five (5) + years of experience in providing service and advocacy in health insurance
• Excellent knowledge of state and federal rules and regulations pertaining to Medicaid and Medicare health insurance
• Excellent knowledge of local, state, and federal family support resources for beneficiaries
• Demonstrated ability to work as a change agent within an organization and advocate with senior staff as needed, on behalf of members.
• Ability to establish relationships with internal departments to collaborate for the benefit of the members.
• Strong oral and written communication skills; strong interpersonal skills; ability to facilitate cross-functional workgroups.
• Effective problem-solving skills: ability to manage multiple tasks; well-developed personal and organizational skills.

• Self-motivated team member; able to work independently as well as a member of a high functioning, dynamic team.

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.