Senior Care Advocate

Location: Lynwood, CA 

Schedule: Full Time: 40 Hours/week - 8am - 5pm 

Pay: $24 - $26 - Depending on Experience

Job Type: Temporary Assignment

Job Summary: Assist in the coordination of essential clinic services and promote participant satisfaction and retention via consistent, high quality, customer service skills. Focus is on assisting participants with inquiries, services requests, eligibility issues, complaints, and appeals. Responsibilities also include documentation and processing of incident reports, documentation and coordination of disenrollment’s, as well as facilitation of on-site satisfaction surveys. Works collaboratively with interdisciplinary teams to achieve program and organizational goals while adhering to established state and federal regulations.

Key Responsibilities:

1. Provide excellent customer service to internal/external customers in efforts to ensure a satisfactory participant experience in the PACE program through use of the service recovery model.

 2. Interface with contracted providers and government agencies (DPSS, LACDHS) and complete any case management tasks necessary to identify and release Medi-Cal hold status and Medicare interruptions, in order to assure continuous PACE enrollment. 

3. Receive service quality complaints and grievances and work to resolve them in a timely manner using the service recovery strategies and in accordance with policies and procedures. 

4. Document and complete participant incident reports, collaborating with Interdisciplinary Team to ensure effective reporting, follow up, and resolution. 

5. Lead retention team efforts to identify service delivery issues/concerns, and minimize disenrollment’s. 

6. Process internal and external service denial appeals by assuring proper documentation in accordance with policies and procedures, and follow up through to resolution. 

7. Ensure accurate and timely documentation in participant electronic medical record and other appropriate databases/trackers 

8. Perform audit surveillance tasks as assigned to monitor adherence to established protocols, policies, and procedures. 

9. Attend monthly Participant Advisory Council meetings and other meetings as assigned. 

10. Coordinate on-site participant surveys, make recommendations regarding strategies for improvement of the participant’s experience, and lead process improvement efforts as assigned.

 11. Perform other duties as assigned.

Work Environment:

Will be exposed to outside environmental conditions while traveling for home visits, or other community meetings as assigned.

Required Skills and Abilities:

1. Strong oral and written communication skills.

2. Critical thinking for problem solving and effective communication 

3. Ability to organize and prioritize goals and responsibilities. 

4. Proficient with computer software such as Microsoft Office applications (MS Word, Excel, Access). 

5. Excellent customer service and facilitator skills. 

6. Thorough, detail-oriented, able to follow through and work semi-independently. 

7. Ability to interpret applicable DHCS and CMS regulations. 

8. Basic knowledge of HIPAA guidelines and requirements.