• Senior Care Advocate

    Location US-CA-El Monte
    Job ID
    2018-7042
    Category
    Customer Service
  • Overview

    Under the direction of the Social Work Supervisor, the Senior Care Advocate works to coordinate PACE services and improve retention. The Senior Care Advocate focuses on improving perception of care and overall satisfaction by assisting participants with inquiries, service requests, eligibility issues, complaints, grievances, and appeals. Responsibilities also include new enrollee orientation, completion and processing of incident reports, tracking and coordination of dis-enrollments, monitoring and follow up of eligibility issues, as well as coordination of on-site satisfaction surveys. Will work collaboratively and effectively with interdisciplinary teams to achieve program and organizational goals.

    Responsibilities

    1. Provide excellent customer service to internal/external customers in efforts to ensure a satisfactory participant experience in the PACE program.
    2. Interface with contracted providers and government agencies (DPSS, LACDHS) to identify and release Medi-Cal hold status and Medicare interruptions in order to assure continuous PACE enrollment.
    3. Receive service quality complaints and grievances and work to resolve them in a timely manner using ALTA service recovery strategies and in accordance with policies and procedures.
    4. Document and complete P/P/C incident reports, collaborating with Interdisciplinary Team to ensure effective reporting, follow up, and resolution.
    5. Lead retention team efforts to identify service delivery issues/concerns, and minimize disenrollments.
    6. Process internal and external service denial appeals by assuring proper documentation in accordance with policies and procedures, and follow up through to resolution.
    7. Coordinate new enrollee introduction and orientation to PACE program and services.
    8. Ensure accurate and timely documentation in participant electronic medical record and other appropriate databases/trackers
    9. Perform audit surveillance tasks as assigned to monitor adherence to established protocols, policies, and procedures.
    10. Attend monthly Participant Advisory Council meetings and others as assigned.
    11. Coordinates on-site participant surveys, makes recommendations regarding strategies for improvement of the participant’s experience, and leads process improvement efforts as assigned.
    12. Other duties as assigned.

    Qualifications

    1. High School Diploma or equivalent with a minimum of 2 years’ customer service experience required. Bachelor’s degree preferred.
    2. CPR/First Aid certificate required.
    3. Knowledge of Medi-Cal, Medicare, and Social Security benefits is required. PACE program knowledge preferred.
    4. Experience in PACE operations, managed care operations or in other healthcare setting serving the frail or elderly is preferred.
    5. Bilingual: Spanish/English, or Chinese/English is preferred.

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