Manager, Member Advocate and Outreach, Texas Territory (DentaQuest)

You are as unique as your background, experience and point of view. Here, you’ll be encouraged, empowered and challenged to be your best self. You'll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, you'll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Candidate must live in the state of Texas.

JOB SUMMARY:

The Member Advocate and Outreach Manager has direct oversight to lead and organize efforts for the advocacy of members included, but not limited to preventive dental care, access to care, education, complaints and grievances, appeals, and dental home. In addition, attendance at health fairs and community events as needed.

PRIMARY JOB RESPONSIBILITIES:

• Facilitate the delivery of preventive dental services for eligible members every six months beginnings six months of age.
• Facilitate the delivery of preventive dental services for new members within 90 days of enrollment.
• Ensure members receive educational materials upon enrollment regarding the services available through the Texas Health Steps program and how to obtain them. Educational material also includes information on:

1) Member’s rights and responsibilities

2) The complaint process and appeal process

3) Medically necessary covered services available to them, including preventive services

4) Non-capitated services

• Assist Children of Migrant Farm Workers receive prompt delivery of service, as they might transition into and out of the dental program more rapidly than the general population. This includes coordinating with their provider to make certain they receive preventive dental services prior to leaving Texas (“accelerated services”) if their routine checkup is scheduled after they leave Texas.
• Understand the cultural and socio-economic characteristics of their region(s). Develop a strong presence in local communities through partnering with organizations that advocate for and serve low-income children. These relationships aid in the member advocate’s ability to refer members to community resources that can accommodate members’ needs if the services are not medically necessary covered dental services.
• Assist members, either in person or via telephone, with writing complaints. The incumbent monitors complaints through completion.
• Collaborate with customer service staff to ensure members are contacted for dental appointments to be scheduled in a timely manner (within 30 days for routine care).
• Establish and maintain a process to manage dental care and continuity of care for individuals with special health needs.
• Collaborate with DentaQuest management, internal departments, and HHSC to plan, evaluate and implement activities to improve access and appropriate care to members. This includes making recommendations on changes that may improve either the care provided, or the way care is delivered.
• Manage all aspects of the dental home process in their region. This includes tasks such as assisting members with finding a dental home, coordinate case management for various populations including special needs and Children of Migrant Farm Workers, maintaining the data for reporting dental home activities, and coordinating outreach efforts.
• Submit tracking and trending reports related to dental home, member advocacy, migrant worker, care coordination and case management performance measures to DentaQuest management. Identify disparities, opportunities for improvement and recommended solutions.
• Help maintain and increase dental access requirements in compliance with dental home components, Medicaid, CHIP and Frew guidelines.
• Assist in the formal training of all new and existing team members.
• Assist in providing mentoring, coaching and feedback to team members.
• Assist in the managing the workflow of Member Advocate Specialist to ensure advocacy requirements are being met.
• Adhere to DentaQuest business processes.
• Other duties as assigned.

JOB REQUIREMENTS:

• 5 years of related experience in healthcare, advocacy or customer service.
• Demonstrated proficiency in claims processing an