Immediate Need for Healthcare Benefits Navigator in Miami, FL

Transcription

1 Immediate Need for Healthcare Benefits Navigator in Miami, FL Positive Healthcare, AIDS Healthcare Foundation's Managed Care Division, has provided people living with HIV quality health care since 1995 when it started the nation s first Medicaid health plan for HIV-positive people living in Los Angeles. Today, Positive Healthcare cares for more than 7,000 lives in California and Florida. PHP (HMO SNP) PHP is a Medicare Advantage Prescription Drug health plan specifically for Medicare beneficiaries who are living with HIV and reside in Duval, Broward and Miami-Dade Counties. PHP is the first HIV-specific special needs health plan approved by the Centers for Medicare & Medicaid Services (CMS). This plan covers routine doctor and specialist office visits, emergency and urgent care, hospitalization, and more. It also includes a prescription drug benefit for no monthly premium. PHC Florida PHC Florida is a Medicaid managed care plan designed specifically for HIV-positive individuals who are eligible for Medicaid and live in Broward, Miami-Dade and Monroe Counties. PHC Florida is a Managed Medical Assistance (MMA) plan offered through Florida s statewide Medicaid Managed Care Program Job Overview The Healthcare Benefits Navigator (HBN), under the direction of the HBN supervisor, is responsible to connect his/her daily activities to the mission and core values of the organization and provide a positive experience to patients, AHF s health plan members, prospective members/patients, providers and internal staff. The HBN is the core of AHF s We ll Walk You Through It (WWYTI) program, which provides personal support to HIV-positive individuals in Broward and Dade Counties who need hands-on guidance and assistance to apply for and access health care and/or prescription drug coverage, AHF services and other community-based services. The HBN not only assists clients in an office setting, he or she may accompany clients to government offices to assist in the coordination and completion of benefit applications. Page 1 of 5

2 The HBN has extensive knowledge of the county-funded, state and federal health care and prescription drug programs available in the counties to which he or she is assigned. The HBN also maintains certification to provide counseling services and assistance for enrollment into Federal Exchange health plans. The HBN provides services to needy individuals in a compassionate and caring manner. He or she is responsible to deliver services that ensure clients and internal/external providers positive experience. He or she works directly with HIV-positive individuals in need of assistance; AHF Healthcare Center, Managed Care, Pharmacy, Community Outreach and Sales staffs; and outside referral sources, i.e., AIDS service organizations. Essential Duties & Responsibilities Includes the following. Other duties may be may be assigned. Demonstrates a caring and concerned attitude when interacting with clients and staff. Delivers services in a culturally competent manner at all times. Maintains and manages an active client load in compliance with AHF policies, procedures and service delivery standards. Obtains and maintains knowledge on HIV, social determinates of access to care, psycho-social issues related to stigma, gender identity, sexual preference, discrimination. Participates in a minimum of 8 hours per year approved HIV and other relevant education per year. Thoroughly understand eligibility and redetermination (if applicable) requirements and application processes for the following programs. Be able to articulate these programs services and benefits and eligibility requirements to clients. Assist clients in a culturally and linguistically sensitive manner in determining eligibility and applying for: o State disability and Medicaid through the Florida Department of Children and Families o Social Security Disability Insurance (SSDI) through the Social Security Administration o Ryan White medical and AIDS Drug Assistance Program (ADAP) services through county health department/ryan White offices o Project AIDS Care (PAC) Waiver services though Agency for Health Care Administration (AHCA) o Federal Health Insurance Exchange health plans on o Patient assistance programs through pharmaceutical manufacturers Page 2 of 5

3 o Other state-, county- and community-based services, i.e., food stamps, cash assistance, housing, etc. o General knowledge of third party insurance regulations to assist individuals with grievance, benefit acquisition, pharmacy access and cost share/copayment/out of pocket expense, etc. issues. Stay current on eligibility, redetermination and application requirements for the aforementioned programs. Obtain and retain certified application counselor certification for the Federal Health Insurance Exchange. Intake, triage and prioritize requests for assistance via telephone, website, , etc. Document all service requests, services provided and redetermination dates, if applicable. Look up client eligibility and demographics in the following systems as needed if client is a current or prior patient or health plan enrollee: o RAM HealthSuite o PosiTrak o Centricity o Passport Documents all contacts in client record, personal action plans, resource recommendations/referral, progress and other pertinent information. In-service referral sources about the scope of services offered through the WWYTI program and the process for engaging prospective clients who need such services. Provide benefit counseling and application assistance services in-person to clients at AHF facilities, state and county offices, and other locations in the field as necessary. Enter new client and enrollee leads for pharmacy and AHF s Medicare Advantage health plan respectively into AHF s Salesforce application. Refer new potential AHF Healthcare Center patients to the clinic of their choice. Refer Florida Medicaid prospective enrollees who wish to enroll in PHC Florida to AHCA s Choice Counseling enrollment broker. Page 3 of 5

4 Work with the WWYTI team to develop checklists/client resource materials per benefit/insurance type to ensure uniform information is distributed to clients and staff. Follows up on phone or electronic inquiries within one business day. Follows through and responds to commitments made to client and/or staff in a timely manner at all times. Develop and maintain current benefit resource lists, e.g., agencies for co-pay assistance, housing, legal advice, transportation, insurance network information, etc. Prepare utilization and productivity reports for management review. Other duties as assigned. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Bachelor degree or higher in social or health sciences, one year experience in benefit or health care administration. Associate degree in social or health sciences with two years of experience in benefit or health care administration. Greater than five years of experience working in relevant health benefit/member services administration. Other Skills & Abilities/Qualifications Excellent organizational skills. Excellent telephonic and in-person interpersonal and customer service skills. Page 4 of 5

5 Familiarity with Ryan White programs and Medicaid and/or Medicare sponsored programs, commercial insurance principles. Basic knowledge of HIV/AIDS services and receive necessary training on HIV funding streams. Sensitivity to the issues surrounding HIV and AIDS. Skill in communicating openly on sexual topics without prejudice or judgment. Must have vehicle, state issue driver s license, and carry automobile liability insurance. Must be able to drive locally up to 50% of the time to accommodate field activities and appointments. We offer competitive salary commensurate with experience and an excellent benefits package including paid vacation, holidays, 401k plan, medical, dental and vision. To learn more about this opportunity, please visit for immediate consideration EOE/AA Principals Only Page 5 of 5