Health Advocate- Call Coordinator, Healthy Outcomes Team – Remote

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The Health Advocate within the Healthy Outcomes Team interacts with members via multiple channels (digital, telephone) and conducts outreaches to our Medicare members to inspire and encourage healthy behaviors through innovative, compassionate and empathetic communications. The goal of each outreach is to ensure that every member has a clear understanding of the available benefits that are afforded to them under their Medicare plan for specific screenings and medications.

The Health Advocate delivers provider and member telephonic outreaches to ensure receipt of important health services, medications and resources to improve Star health outcomes.

The Health Advocate provides support for Healthcare Effectiveness Data and Information Set (HEDIS) quality initiatives by performing the following:

• Work on one or more of multiple departmental programs that include:
• Inbound and outbound calls to members who would benefit from designated services including healthcare visits/ screenings, vaccination, or medication refill.
• Effective capture of barriers and data collection, use of motivational interviewing skills to provide solutions to facilitate closing gaps in care, and providing best in class support to each member.
• Ensures that every customer is treated professionally, with respect and all questions are thoroughly answered and/or triaged and responded to.
• Acts as an advocate for our Medicare membershealthneeds and helps coordinate care between health plan, doctors and pharmacies.
• Actively listen and collect member reported data elements in the CRM tool to support medical record chasing for HEDIS medical record documentation of services.
• Provides members with the right information at the right time to help them make better decisions about their health and health care, to improve member experience, retention, and growth by efficiently delivering coordination services to members and providers .
• Engages, consults, and educates members based upon the member’s unique needs, preferences and understanding of the services.
• Accepts end to end accountability for the member experience and provides exceptional service.
• Answers questions and resolves issues as a “single-point-of-contact” including escalating to leadership as needed.
• Builds a trusting relationship with the member by taking accountability to fully understand the member’s needs.
• Walk members through programs, Aetna tools and resources to support health care behavior.
• Takes ownership of each member assigned to resolve their issues and connect them with additional services as appropriate.
• Documents and tracks all member contacts, events, and outcomes via appropriate systems and processes.
• Uses professional communication skills to build relationships with both internal and external members/constituents.
• Uses applicable system tools and resources to produce quality business communications including letters and spreadsheets in response to inquiries received.
• Handles multiple functions and/or multiple products while maintaining and/or exceeding performance standards.
• Identifies issues that need to be escalated appropriately and offers suggestions for resolution.
• Demonstrates professionalism and presents a positive image of the company when interacting with members and constituents.
• Supports individual, team and…