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LTSS Member Advocate

Primary Location: Overland Park, KS
Additional Locations: KS-Overland Park
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Description:
The position is dedicated to work with the health plan’s LTSS members and providers to facilitate the provision of benefits. The LTSS Member Advocate is responsible for making recommendations to the health plan management team regarding any changes needed to improve either the actual care provided or the manner in which the care is delivered. The person assign to this position must have substantial at least two [2] years experience in health care, preferable working with low-income populations, and have demonstrated cultural sensitivity.

Fundamental Components:
  • Investigate and resolve access and cultural sensitivity issues identified by the health plan staff, State staff, providers, advocate organizations, and members
  • Monitor the health plan’s formal and informal grievances with the grievance personnel to look at trends or major areas of concern; discuss these reports with community advocates, if requested coordinate with schools, community agencies and State agencies providing services to members
  • Recommend policy and procedural changes to the health plan’s management including those needed to ensure/improve member access to care and quality of care; changes can be recommended for both internal administrative policies and provider requirements
  • Function as a primary contact for member advocacy groups; work with these groups to identify and correct member access barriers
  • Participate in local community organizations to acquire knowledge and insight regarding the special health care needs of members
  • Analyze systems functions through meetings with staff
  • Organize and provide training and educational materials for the health plan’s staff and providers to enhance their understanding of the values and practices of all cultures with which the health plan interact
  • Provide input to management on how provider changes will affect member access and quality/continuity of care; develop/coordinate plans to minimize any potential problems
  • Review all informing material to be distributed to members
  • Assist members and authorized representatives obtain medical records


Background Experience:
  • Performs other related duties and special projects as assigned.
  • Maintains availability/willingness to travel to various locations as frequently as necessary to meet business needs (if travel is required)Maintains availability and willingness to work the schedule necessary to meet business needs
  • Works in a manner that is not disruptive to peers, supervisors and/or subordinates.
  • Effective interpersonal skills and ability to act as a team player.
  • Statistical analysis skills helpful.Ability to pay attention to detail, work in a fast paced/evolving environment.
  • Capable of meeting deadlines on a consistent basis.
  • Effective organizational skills and ability to manage multiple tasks.
  • Proficiency with word processing, spreadsheet applications, database management and graphics experience.
  • Microsoft Office Suite preferred Ability to successfully interact with members, medical professionals and health plan and government representatives.
  • Effective telephone, oral and written communication skills.
  • Bilingual preferred.
  • Cultural Competency training experience preferred.
  • Minimum 2 years managed care or community relations experience.


Potential Telework Position:
No

Percent of Travel Required:
50 - 75%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

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