The Health Care Advocate, as part of the Independent Consumer Advocacy Network (ICAN), the New York State Ombudsprogram for Managed Long-Term Care, will assist seniors and people with disabilities as they transition into and navigate Medicaid Managed Long-Term Care (MLTC). The Advocate will work with consumers to resolve issues with their MLTC plans.
Reports to: Director of Services
Duties and Responsibilities:
- Provide direct in person consumer assistance, advocacy, and education for MLTC participants/caregivers by explaining enrollment and disenrollment, benefits, coverage and access rules and procedures, member rights and responsibilities, and appeals. Information will also be provided through distribution of written material.
- Answer a live legal helpline during assigned shifts.
- Assist participants/caregivers with raising and resolving quality of care and quality of life issues. Train other community based organization advocates on these and other issues, and prepare do it yourself template materials for participants/caregivers to use.
- Assist participants/caregivers with accessing records from the Managed Long-term Care plans.
- Explain the grievance and appeal process, and assist participants/caregivers in resolving problems and issues using skilled negotiation techniques and providing assistance in filing grievances and appeals when informal problem resolution proves unsuccessful.
- Provide consumer outreach and education presentations at other community based organizations and to participants/caregivers and advocates. Assist with developing and maintaining an outreach and education campaign.
- Comply with all legal requirements established by NY State Department of Health for obtaining consent, ensuring access to records, coordinating contacts with plans, coordinating referrals, and for ensuring confidentiality, and protect against inappropriate disclosures of identifying information.
- Ensures all significant client data and service provision details are current and accurate, and that they are documented in a timely manner into CIDNY’s and the contracted provider’s databases.
- Maintain quality assurance procedures established. Conduct quality assurance reviews of cases, using case notes and information reports in the database, of five to ten percent of randomly selected cases.
- Attends Agency's in-service training and unit meetings as well as any other agency-related activities. Conduct trainings regarding client education, navigational and appeal services, consumer rights and responsibilities.
- Identify systemic trends or practices that affect people with disabilities and seniors and work closely with other stakeholders to design a systematic response. Assist in preparation of reports concerning the program. Research as required.
- Other responsibilities identified by Supervisor.
Education and/or experience required:
- Must have earned a JD and be admitted to the practice of law in NY or pending admission
- Demonstrated experience providing assistance to people with health insurance and health care access issues.
- Previous work with the disability community a plus.
- Personal experience with disability a plus.
Skills, Licenses, and/or competencies required:
- Knowledge of health care coverage information, eligibility rules, and resources information.
- Excellent interpersonal skills, knowledge of social service delivery systems, knowledge of government/benefits resources, good organizational, and communication skills;
- Strong advocacy skills and effective communication skills required.
- Individual must have time management skills to maintain individual/community outreaches, caseload, documentation and administrative requirements;
- In addition, the ability to work well independently as well as part of a team;
- Must be computer literate of basic Microsoft Programs;
- Research skills and knowledge of Medicare and Medicaid law and policy desired. Knowledge of the Americans with Disabilities Act preferred.
- Respectful and comfortable with persons from different cultural and socio-economic backgrounds.
- Ability to speak a language other than English strongly preferred.
We conform to all laws, statutes, and regulations concerning equal employment opportunities and affirmative action. We strongly encourage women, minorities, individuals with disabilities and veterans to apply to all of our job openings. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, genetic information and testing, family and medical leave, sexual orientation and gender identity or expression, protected veteran status, or any other characteristic protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer or the government, or against any individuals who assist or participate in the investigation of any complaint or otherwise oppose discrimination.
HOW TO APPLY
Please send a thoughtful cover letter and resume to Paige Munson, Director of Services, email@example.com. Do not send by fax.
Please use the job title as email header. NO PHONE CALLS PLEASE.
Salary: $62,000 + Excellent benefits package