Senior Service Advocate - Ops

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Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Program Overview

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

Position Summary

The Health Survey Specialist plays a critical role within the DSNP team. The Health Survey Specialist outreaches DSNP members via phone to introduce the DSNP services and complete the Health Risk Assessment (HRA). The HRA is the first step in creating the member’s Individualized Care Plan and sets the foundation for follow up care management by assessing a member’s medical, functional, cognitive, psychosocial, and mental health needs.

Fundamental Components

• Uses motivational interviewing and other consultative techniques to gather comprehensive information about a member’s medical, functional, cognitive, psychosocial, and mental health needs
• Accountable to the highest level of compliance integrity
• Champions for the member by connecting members with urgent needs to the appropriate Aetna team, including DSNP’s interdisciplinary care team and customer service
• Initiates engagement with assigned members to introduce the program and drive active participation in completion of their Health Risk Assessment
• Builds a trusting relationship with the member by engaging the member in meaningful and relevant conversation, prior to and during assessment
• 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
• 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
• 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

Background Experience

Required Skills

• At least 3 years of experience in health care, customer service, telemarketing and/or sales
• Familiarity with basic medical terminology, health care, and the concepts of care management
• Experience with computers, including knowledge of Microsoft Word, Outlook, and Excel required
• Data entry and documentation within member records is strongly preferred
• Flexibility with work schedule to meet business needs

Preferred Skills

• Strong organizational skills, including effective verbal and written communications skills required
• Medicare/Medicaid/DSNP experience preferred
• Bilingual Spanish
• Associates/Bachelor’s degree preferred

Education and Certification Requirements

• High School diploma or G.E.D. required

Pay Range

The typical pay range for this role is:

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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.