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UnitedHealth Group Senior Consumer, Caregiver Advocate - Waltham, MA in Waltham, Massachusetts

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

UnitedHealthcare Community & State Senior Care Options plan is a Fully Integrated Dual-Special Needs Plan (FIDE-SNP) serving dually eligible individuals in the Commonwealth of Massachusetts aged 65 or greater. This position reports to the Manager of Advocacy in the Operations Department within the Senior Care Options Plan.

This position will ensure coverage on member and caregiver cases and, in addition, will provide additional support in compliance areas including MyOmbudsman cases, Appeals & Grievances monthly reporting, and eliciting/responding to member and caregiver feedback (focus groups, consumer advisory meetings). They will assist with member/caregiver process improvements and satisfaction efforts. The ideal candidate must be bi-lingual and have a Master’s degree (ex: Master of Social Work). Licensure preferred in MA (ex: LICSW). Ability to think creatively regarding process improvements and execution of initiatives will be critical. Our team thrives on a culture of inclusion and respects diversity. Compassion and a commitment to social justice and equity is required.

Primary Responsibilities (Consumer Advocacy):

  • Supports resolution of complex member inquires and supports member satisfaction work:

  • Analyzes, investigates, and resolves member inquiries (including via member walk-ins), MyOmbudsman issues requiring coordination with members, providers, sister segments and internal departments (such as clinical services, provider relations and quality). May support State Board of Hearing appeals

  • Assesses, anticipates, and interprets enrollee needs and requirements; identifies solutions to non-standard requests and problems and oversees process improvement activities as a response to feedback

  • Develop relationships and collaborate with internal and external stakeholders (e.g., A&G, Call center, sister segments) to identify their needs and ensure proper delivery of our services/solutions, as needed

  • Participate in efforts focused on medical, behavioral, and social determinants of health factors that improve the well-being of SCO members and improve member satisfaction (Net Promoter Score, NPS)

Primary Responsibilities (Caregiver Advocacy):

  • Support efforts of CG program including attending Steering Committee and assisting in the development of plan level caregiver engagement initiatives

  • Co-leads efforts to collect and analyze caregiver input (via focus groups or surveys) to inform the family caregiver program

  • Assists family caregivers by providing support, offering resources and recommendations upon referral

  • Provide education at clinical team meetings on CG program initiatives and referrals

  • Collaborate with care teams, sales/outreach teams and others to achieve program goals

  • Serve as liaison between members, caregivers and internal business leaders to ensure mutual understanding of needs and clear expectations by all stakeholders

  • Assists in the development and maintenance of resource tools for family caregivers

Primary Responsibilities (Other Advocacy):

  • Develop strategies supporting plan level member engagement initiatives to enhance the member voice within the plan including co-leading consumer advisory council (CAC), and town halls, surveys, and focus groups. Meet compliance requirements of these required activities

  • Support efforts to evaluate and analyze member satisfaction metrics/data through the Service Quality Improvement Committee and participate in action plans to increase member satisfaction

  • Trains health plan and other UHG teams on the member population and Senior Care Options program design. Develops training materials and conducts monitoring activities with shared-service partners

  • Documentation & Maintenance of policies and best practices for communication and case resolution (QRG)

  • Oversight of required monthly Appeals & Grievances state reporting including oversight of team assigned to work, meeting compliance deadlines, and analyzing root cause and resolving issues in processing data in partnership with National Appeals & Grievances team

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Master’s degree

  • 1 year of experience working with Medicaid/Medicare programs

  • Proficiency in Microsoft Office (Word, Excel, PowerPoint)

  • Ability to understand the needs of the geriatric population and that of their family caregivers

  • Ability to understand the needs of individuals with disabilities and that of their family caregivers

  • Willingness and ability to travel up to 25% within Massachusetts

  • Bilingual

Preferred Qualifications:

  • Master’s degree in Social Work, RN, or health related field

  • Professionally licensed clinician (i.e. LCSW, LICSW) in MA

  • Experience working with Massachusetts Medicaid/Medicare programs

  • Proven track record of building and maintaining community-based relationships

  • Commitment to diversity, equity and inclusion

  • Presentation skills and ability to speak in front of diverse audiences (leadership, external entities, members, and providers) as well as facilitate a meeting

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Senior Consumer, Caregiver Advocate, Medicaid, Medicare, Waltham, MA, Massachusetts