MLTC Sales Representative II

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Managed Long Term Care (MLTC) Sales Representative provides access to MLTC insurance, by providing education and assistance to long term care recipients. The MLTC Sales Representative provides education on Managed Long Term Care features and benefits to consumers, providers, and business partners.

• Educate and enroll Medicaid eligible for the MetroPlusHealth Managed Long Term Care product.
• Identify eligible Medicaid consumers via Home Care Agencies, Adult Day Care Centers, DME Provider offices, Caregiver Resources Centers, specialty provider offices, HHC Long Term Care Facilities, etc.
• Understand and apply all policies and procedures pertaining to:
• Disclosures and provisions of the various MetroPlusHealth Plan products.
• Enrollment and disenrollment for each line of business.
• Remain knowledgeable of services available and utilized by Medicaid consumers eligible for MLTC, i.e., In Home Services for the Elderly Program, Housing Options, Government Benefits, shopping assistance, exercise classes, meals on wheels, etc.
• Responsible for understanding the basic concepts, features, benefits of MetroPlusHealth MLTC product.
• Responsible for selling the services provided by the Plan, such as covered benefits, non-covered benefits, exclusions and exemptions.
• Provide education on Managed Long Term Care features and benefits to consumers, providers, and business partners.
• Responsible for remaining informed of, and adhering to, marketing activity guidelines as set forth by various agencies such as; HRA, DSS, SDOH.
• Responsible for assisting the consumer with the following:
• Selecting a PCP
• Completing required marketing materials and documentation as determined by MetroPlusHealthand various regulatory agencies such as; HRA, DSS, SDOH.
• Completion of enrollment form, required documents and reports i.e. transmittal reports, batch sheets top process an application for a Medicaid consumer eligible for MLTC.
• Follow up on "Leads" and "Referrals" from family members, and caregivers of consumers eligible for enrollment in the MetroPlusHealth MLTC product.
• Responsible for maintaining an adequate supply of marketing materials at times.
• Responsible for meeting marketing enrollment goals as set forth by the Plan.
• Conduct presentations to Home Care Agencies, support groups, caregiver trainings, etc. as well as conduct home visits, and personalized appointments as needed to complete the enrollment process.
• Ensure that promotional activities are conducted to promote the MetroPlusHealth MLTC product, (i.e., placement of signage and brochures in patient waiting areas, conduct outreach calls, participate in events/health fairs and workshops attended by consumers, caregivers, and providers) including evening and weekend hours.
• Work closely with Outreach Representatives, Member Service Representatives, Eligibility Representatives, Utilization Management, and other MetroPlusHealthpersonnel to resolve member concerns regarding complaints and potential enrollment or disenrollment.
• Establish and sustain beneficial relationships with the Home Care Providers, Caregivers, medical specialist (Occupational/ Physical/Speech/Rehabilitation Therapist), Home Health Aides, Mental Health and Substance Abuse Providers, social workers, discharge planners and other providers that work with the Medicaid Long Term Care patients.
• Responsible for participation in weekly, bi-weekly, and monthly full staff, team and one-on-one meetings.
• Recognizing and implementing new marketing opportunities.
• Assisting members in accessing health care needs and other services as needed.
• Establish and maintain good working relationships with provider organizations and community organizations where marketing activities are conducted.
• Promoting the Vision, Mission, Values and Goals of MetroPlusHealth Plan.
• Conducting and participating in telemarketing/outreach efforts as required.

• Must have a High School Diploma or GED, College Degree or coursework preferred
• 2-3 years of Sales experience required
• Managed Long Term Care experience preferred
• Valid NYS Driver's License is a plus
• New York State Life, Accident and Health Insurance Agent License

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication

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