Available Locations: MACON or ATHENS

JOB PURPOSE:

The purpose of the Outreach and Enrollment Specialist role for PruittHealth Premier to serve as a licensed insurance agent to explain Plan benefits and answer the questions of potential members or their responsible party. Their role is to identify potential membership leads and help ensure timely outreach to assist with enrollment to the health plan. In addition, they provide ongoing marketing support to our in-network skilled nursing facility staff, conduct facility and community marketing events, and provider education both in our skilled nursing facilities and in our communities to support both our I-SNP and D-SNP as needed.

KEY RESPONSIBILITIES:

This position is considered a work-from-home/traveling position as no formal office space/work location is provided. The Outreach and Enrollment Specialist conducts the majority of their work within local healthcare agencies, low-income resource agencies, hospitals, provider offices, Partner nursing homes, HUD communities, and other medical and social resources for low-income populations in the communities where our D-SNP is offered in the agent’s specific work region.

The following defines the responsibilities of the Outreach and Enrollment Specialist:

1. Serve as a licensed insurance agent to explain Plan benefits and answer potential member resident/responsible party questions;

2. Coordinate with sales leadership to effectively enroll residents into institutional special needs plans (ISNPs); and dual special needs plans (DSNPs)

3. Work effectively with sales administration management for as-needed enrollment admin support;

4. Successfully utilize sales closing skills to drive enrollments, maintaining a strong sales close rate;

5. Properly follow established sales policies and standard operating procedures, effectively utilizing and updating company systems and databases; including systems for entering referrals and enrollments.

6. Ability to learn and carry out Centers for Medicare & Medicaid Services rules and regulations.

7. Meet with potential members/responsible party to ensure that any questions are answered, existing benefits are compared to plan benefits and to act as a point of contact if the potential member or their family needs assistance during the enrollment process.

8. Assist in creating materials and conduct extensive outreach to inform community of available health plans and other health services.

9. Locate upcoming events at which to conduct outreach activities and maintain calendar of such events. Market Medicare Advantage on-site at senior centers, food pantries, community events and other sites as designated

10. Provide educational material regarding insurance options and organization’s services to community partners including health departments, hospitals, urgent care and human services agencies and coordinate outreach efforts with these groups

11. Identify and engage with key community leaders and relevant organizations whose work is aligned with the DSNP population

12. Offer to participate in facility events for marketing of the plan in accordance with CMS guidelines.

13. Send weekly lists of eligible enrollees to facility contacts; agency contacts each week.

14. Ensure that all interactions with the member are compliant with CMS regulations

15. The Outreach and Enrollment Specialist will be responsible for a geographic territory of participating nursing facilities and counties for D-SNP marketing and enrollment within that same territory if applicable.

16. Maintain current license to sell life and health insurance and AHIP certification to maintain employment in this role.

KNOWLEDGE, SKILLS, ABILITIES:

• Bachelor's Degree or substantial insurance sales experience;

• Health Insurance License;

• Strong technological skills to connect with potential members/families interested in enrolling

• Ability to maintain health insurance licensure and Continuing Education Requirements set forth by licensing state;

• Comfortable/patient in communicating via web-based video platforms;

• Assertive self-starter who is able to influence others;

• Strong written and verbal communication skills with abilities to deliver presentations in an impactful manner;

• Effective in a variety of communication settings: one-on-one, small and large groups, or among diverse styles and position levels

• Proven ability to work independently and productively.

• Strong computer skills and proficiency in Microsoft Office Suite products;

• Willingness to travel to local meeting places as needed;

• Substantial sales experience;

• Knowledge of Medicare/Medicaid and/or nursing community dynamics.

• Demonstrate compliance with CMS regulations regarding Medicare Advantage Plans and PruittHealth Code of Conduct.

• Demonstrate exceptional interpersonal skills with ability to work independently as well as with a team.

• Exceptional organizational skills; strong written and verbal communication and clear-thinking skills with the ability to synthesize complex issues into simple messages;

• Willingness and ability to travel to facilities within your assigned region; have dependable transportation, a current driver’s license, a clean driving record, and proof of insurance;

• Have suitable home workspace allowing for productive office environment.

• Understands the PruittHealth Premier Plan benefits, PruittHealth Premier Plan policies, procedures and articulate them effectively to providers, potential members and key decisions makers.

• Complete annual Medicare Fraud, Waste and Abuse Training and Model of Care Training

• Performs other duties as assigned

MINIMUM EDUCATION REQUIRED:

Bachelor’s degree preferred.

MINIMUM EXPERIENCE REQUIRED:

2 years health insurance sales experience preferred.

2+ years of outside sales and marketing experience required, with strong preference for candidates with previous experience in Medicare or healthcare sales and engagement.

Previous experience in case management and utilizing community assistance resources preferred.

Excellent communication skills and strong organizational skills needed.

Ability to professionally present plan benefits and financial information

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

None

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

AHIP Certification and Licensed to sell Health insurance in required states. (Required to have this upon hire)

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you! Apply Now to get started at PruittHealth!

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.