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QM Member Liaison Sr (ECF Member Advocate)

  • Job Family: Customer Care
  • Type: Full time
  • Date Posted:
  • Req #: JR34828

Location:

  • TN, Nashville
  • Kentucky, Kentucky
  • TN, Brentwood
  • Alabama, Alabama

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Description

Location: Hybrid (35% of T ravel or Field Work )

Schedule: 1st shift – 8AM-5PM (May require after Weekday Business Hours or Saturday Shift Work)

Responsible for developing, coordinating, and implementing member advocacy initiatives within the Employment Community First CHOICES Program in Tennessee as well as member retention by investigating and leading the resolution of member complaints. Coordinates the member advocacy program throughout the functional areas of the health plan. 

How you will make an impact:

  • Investigates, resolves, and documents member complaints in accordance with policies and state requirements. 

  • Implements comprehensive Member Advocacy Program to meet the needs of members. 

  • Communicates with state agency regarding stakeholder recommendations for program improvement.

  • Collaborates with local consumer advocacy groups to gain insight regarding the special health care needs of Medicaid enrollees. 

  • Facilitate Regional and Statewide Advisory Board and Stakeholder meetings to provide education on ECF CHOICES program and obtain recommendations for program improvement

  • Locate community resources for individuals enrolled in ECF and their families.

  • Attend Community Engagement Meetings to provide ECF program education to the community and schools across the region. 

  • Investigates and resolves issues regarding allegations by members with provider agencies

  • Tracks, trends, and reports quality and access complaints; coordinates and documents follow-up actions. 

  • Serves as a liaison with state agency and internal compliance personnel

Minimum Requirements:

  • Requires a BA/BS degree in HealthCare or related field and a minimum of 5 years of experience in a social or health related service-oriented industry; or any combination of education and experience which would provide an equivalent background. 

Preferred Skills, Capabilities and Experience:

  • Strong preference for those candidates who have experience working with individuals in the Intellectual and Developmental Disabilities fields, familiarity with ECF CHOICES, the DIDD 1915c Waiver Programs, and ICF/IDD.

  • ECF Member Advocate strongly preferred.


Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.

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