Program Consultant Quality/Member Rights Specialist Wisconsin Family Care

Elevance Health • Waukesha, WI

9d • Hybrid

About The Position

The Program Consultant Quality/Member Rights Specialist will be responsible for member rights and performs quality reporting to DHS, including Critical Incident reporting. Program consultants typically support business strategies through an integrated portfolio of external client facing projects or initiatives.

Requirements

• Requires a BA/BS in a related field and minimum of 3 years experience in external client facing program management; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Graduate degree, professional designation related to field or project management experience preferred.

Responsibilities

• Performs quality reporting to DHS, including Critical Incident reporting.
• Serves as a member advocate and works directly with members to assist with navigating care, appeals and grievances, maintaining income eligibility, and other member rights-related needs.
• Ensures the Member Rights Specialist/quality function remains fully independent from other health plan functions, consistent with contractual requirements.
• Works with members, income maintenance agencies, ADRCs, and other partners to gather information needed to maintain member eligibility.
• Executes Member Rights Specialist and quality reporting activities within contractually-defined timelines and requirements to reduce risk of non-compliance and associated penalties.
• Manages the development, approval, implementation and compliance of on-going external client facing programs.
• Develops program budget.
• Ensures program meets its stated objectives.
• Provides subject matter expertise in response to day to day business issues.
• Researches applicable subject matter practices and remains aware of industry trends.
• Manages relationships and partners with corporate and regional business areas.
• Coordinates training related to the external client facing program.
• Develops program success measures and performs periodic assessments of external client facing program success.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level