Member and Family Advocate

Johnstown PA 15906

Job Description

This position serves as the primary liaison between Magellan and service recipients, their families and other support individuals. This position is a source of information and referral; serves as a guide for families seeking services and solutions on behalf of members; advocates for fair processes and aids in answering questions and concerns. This role provides confidential and informal assistance, including participation in informal investigations as needed regarding services, policies and programs. This position acts as a neutral representative and an advocate for fair process, and aids in answering questions and concerns and also provides direct conflict resolution services when needed, including coaching, facilitation and mediation between members, families, employees, providers, clinics and other inter-departmental areas. Ensure appropriate access to care through identification and prevention, analyzing root cause of challenges and identify strategies for resolution
  • Assists members with filing complaints, grievances or appeals; investigates high level/sensitive issues and complaints; assists recipients and their family members in obtaining the right behavioral and/or physical health services.
  • Maintains confidentiality of observations, investigations and communications with or about recipients, recipient representatives and family members as appropriate.
  • Facilitates and supports inter-agency meetings in which system issues are presented. Recommends practice adjustments, policy and procedure revisions, training and support in an effort to provide continuous improvement to elevate the patient experience. 
  • Escalates areas of stakeholder concern and recommends organizational changes to Manager.
  • Participates in committees related to issues affecting the member experience, such as quality, compliance, network development and management and governance.
  • Serves as a liaison and facilitator between members, staff, and representatives of social service agencies and others; maintains a barrier resolution process within and between the system partners to translate system successes and barriers into positive systematic changes.

General Job Information

Title

Member and Family Advocate

Grade

22

Job Family

Clinical Services Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

7/2/2019

Date Requisition Created

7/2/2019

Work Experience

Clinical, Public Health, Social Work

Education

Bachelors (Required), Masters: Behavioral Health (Required)

License and Certifications - Required

License and Certifications - Preferred

LPC - Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt

Other Job Requirements

Responsibilities

Experience with individuals who have severe mental illness or chronic medical conditions.

Managed care experience preferred.

Experience documenting in a clinical record or information system. Knowledge of local community resources and familiarity with health care coding (ICD, DSM).

Experience in community service, health care or social services and/or community-based or home health care experience required

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”