Member Health Advocate

Avera Health Plans

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$22.75 - $34.75

Position Highlights

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

The Member Health Advocate works directly with the Population Health team to assist members who would benefit from through population health activities or case management collaboration with members, physicians, medical management, collaboration with members, physicians, medical management, employers, community services, hospital based case managers and AHP staff to encourage the best possible outcome in the most cost effective manner in accordance with standards set forth by NCQA.

What you will do

• Follows established guidelines and procedures to support members navigating in- and out-of-network care.
• Work collaboratively with key stakeholders involved in the members’ care team, including family members, primary care providers, specialists, and administrative support staff.
• Provide education to members and families to help support informed decision-making. This information can include benefits, coverage, and other details that outline how a service is covered.
• Communicates information effectively and respectfully with individuals and families, utilizing appropriate communication methods and resources to support understanding and accessibility across diverse cultural, linguistic, and communication needs.
• Effectively serves members from diverse backgrounds and communities, ensuring access to information, resources, and assistance specific to individual needs.
• Maintains accurate and complete client data records by collecting all demographics.
• Works with a diverse set of organizations and entities throughout the state in order to effectively serve the large number of people who will be eligible for benefits through Avera Health Plans.
• Works collaboratively with departments throughout Avera Health Plans to foster communication, promote cross-functional collaboration, to drive efficient, customer-focused outcomes.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Associate's

Preferred Education, License/Certification, or Work Experience:

• Bachelor's
• Managed Care experience.
• 1-3 years Experience in insurance, healthcare, or social service industry.

Expectations and Standards

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [email protected].