Member Advocate Remote

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This role will be work at home with 25-40% travel within Northern counties of NJ (Passaic, Bergen, Essex, Hudson, Morris or Union counties).

Standard business hours Monday‑Friday 8:00am‑5:00pm EST.

The Member Advocate is responsible for direct member outreach and engagement. Join us in this exciting opportunity as we grow and expand DSNP into new markets across the country.

Aetna is an industry leader in serving dual eligible populations by utilizing best‑in‑class operating and clinical models. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of our members' health care and social determinant needs. Dual Eligible Special Needs Plans (DSNP) members are enrolled in Medicare and Medicaid.

• Initiates engagement with assigned members to introduce the program and gather updated member demographic information with speed, accuracy, and a positive attitude.
• Schedules completion of the assessment based on the member's preferences and the assigned care manager's schedule.
• Accurately and consistently documents each call in the member's electronic record, thoroughly completing required actions with a high level of detail to ensure we meet our compliance requirements.
• Protects the confidentiality of member information and adheres to company policies regarding privacy/ HIPAA. Effectively supports members during enrollment calls, appropriately managing difficult or emotional member situations, responding promptly to member needs, and demonstrating empathy and a sense of urgency when appropriate.
• Conducts triage, connecting members with appropriate care team personnel including care managers and customer service when needed.
• Ability to be agile, manage multiple priorities, and adapt to change with enthusiasm.
• Determined to build strong relationships with peers and our DSNP members.
• Demonstrates an outgoing, enthusiastic, and caring presence over the telephone.
• Act as a Medicaid recertification specialist for the team.

• This is a remote role with 25-40% travel required; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

• 2 years of experience preferably in customer service, telemarketing, Medicaid, and/or sales.
• Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel - data entry and documentation within member records is preferred.
• Must reside in New Jersey and be able to travel 25-40% to attend member meetings.

• Call center experience preferred. Familiarity with basic medical terminology preferred.
• Flexibility with work schedule to meet business needs.
• Strong organizational skills, including effective verbal and written communications skills.
• Bilingual desired.

• The highest level of education desired for candidates in this position is a High School diploma or G.E.D.

40

Full time

The typical pay range for this role is:
$18.50 - $42.35

This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.