Activities Director

Career Center•Jackson, MS

22h•Hybrid

About The Position

American Health Advantage needs a customer-service focused leader to support local service areas. This role involves coordinating with Insurance Producers to ensure seamless transitions for enrolled members, acting as a primary point of contact for members and their families, and maintaining strong relationships with network providers and facilities. The position requires ensuring member needs are met, providing regular updates, and managing member status and issues. A key aspect of this role is ensuring all interactions are compliant with CMS regulations, particularly for members within assigned nursing facilities.

Requirements

Experience successfully working in a healthcare delivery setting with elderly patients as either a clinician, social worker or caregiver.
Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team.
Must be a good listener to understand feedback raised by the family.
Ability to work well with staff at each of the nursing homes in the assigned region to include nursing staff, doctors and administration staff.
Ability to deliver outstanding customer service with a proven track record.
Compliant, at all times, with CMS regulations regarding Medicare Advantage Plans.
Exceptional organizational skills.
Strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages.
Willingness and ability to travel to facilities within your assigned region.
Have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance.
Strong proficiency in computer skills in Microsoft Office Suite products.
Have suitable home work space allowing for productive office environment.

Nice To Haves

Nursing home experience is preferred.
Insurance or Insurance Customer Service License is preferred; however, not required.

Responsibilities

Coordinate with Insurance Producer to ensure seamless transition between enrollment/customer service success.
Follow up with enrolled members to ensure questions are answered and act as a point of contact for assistance or plan updates.
Act as front-line support for members, partner facilities, and the integrated care team to meet member and plan needs.
Develop and maintain relationships with key network providers/facilities within the assigned region.
Support continued regional network development activities to meet network adequacy requirements.
Meet with the member and/or their family at least monthly.
Follow up on member dissatisfaction and report accordingly.
Develop and maintain reporting, including managing member status, daily/weekly/monthly facility calendars, and issues tracking/management.
Ensure all interactions with the member are compliant with CMS regulations.
Be responsible for a group of nursing facilities and ensure services are carried out for each member in the assigned group.
Other responsibilities as assigned.