Umbra Associate – Founding Member | APHA - The Alliance of Professional Health Advocates

Umbra Associate Membership Application

Please complete the following application. Once we review your application and confirm your eligibility, we’ll send you all the information you need to get started.

Terms:

$399 / Year

First Name:* First Name Required

Last Name:* Last Name Required

Address:* Address is Required

City:* City is Required

State or Province:* State or Province is Required

Zip or Postal Code:* Zip or Postal Code is Required

Country: Country is not valid

USA Canada Other

Country (Outside US and Canada): Country (Outside US and Canada) is not valid

Phone number:* Phone number is Required

Email:* Email is Required

Education: Education is not valid

Experience: Experience is not valid

Current APHA Membership:* Current APHA Membership is Required

I am currently a PACE or PACE International Member I am currently a Premium member I am currently an Umbra Associate Member I am not an APHA Member

This program is designed to help clinicians transition into patient advocacy. Do you have clinical training and/or experience? : This program is designed to help clinicians transition into patient advocacy. Do you have clinical training and/or experience? is not valid

Yes No

What kind of patient advocacy career do you envision for yourself?: What kind of patient advocacy career do you envision for yourself? is not valid

I want to open my own independent practice as soon as I can. I want to provide advocacy services but I don’t want to start or run my own business. I want to get started serving clients as soon as possible without having to do all the set up, but later I may want to launch my own practice.

Which of the following organizations are you a member of, or participant in?: Which of the following organizations are you a member of, or participant in? is not valid

CSA (Certified Senior Advisor) iRNPA National Institute of Whole Health WASHAA Assumption College Cleveland State None of the Above

Why are you interested in advocacy as a career?: Why are you interested in advocacy as a career? is not valid

Web Presence: Web Presence is not valid

Liability Insurance:* Liability Insurance is Required

Are you currently an APHA Member?: Are you currently an APHA Member? is not valid

Where did you hear about the Alliance of Professional Health Advocates?: Where did you hear about the Alliance of Professional Health Advocates? is not valid

Your experience (Please check all that apply):* Your experience (Please check all that apply) is Required

I have worked in a healthcare administrative role I have worked in a healthcare clinical role I have been an unpaid caregiver I have been a non-clinical paid caregiver I have had training in patient advocacy/care management/care coordination None of the above

Which of the following do you have experience doing? (Please check all that apply):* Which of the following do you have experience doing? (Please check all that apply) is Required

Managing health insurance and/or pharmacy benefit issues such as prior/pre authorization, step therapy, denials/appeals, and/or filing medical claims Scheduling appointments, arranging transportation, care coordination, tracking paperwork/records Communicating with medical/service providers, patient education Navigating for additional financial or other assistance (e.g. Disability) for those in need Managing/reducing hospital bills Other

If other, please specify:: If other, please specify: is not valid

Do you have experience advocating for patients with inflammatory bowel disease (IBD), including Crohn’s and/or ulcerative colitis?:* Do you have experience advocating for patients with inflammatory bowel disease (IBD), including Crohn’s and/or ulcerative colitis? is Required

Yes No

If yes, please describe your experience with IBD navigation/advocacy: If yes, please describe your experience with IBD navigation/advocacy is not valid

If no, are you willing to complete APHA/Umbra training module/s on IBD specifically?:* If no, are you willing to complete APHA/Umbra training module/s on IBD specifically? is Required

Yes No

Please include your bio or a link to an online bio for you. Either keep it brief (up to 150 words) or include your full bio and we will trim it for you.: Please include your bio or a link to an online bio for you. Either keep it brief (up to 150 words) or include your full bio and we will trim it for you. is not valid

Do you have Professional Liability / Errors and Omissions insurance?:* Do you have Professional Liability / Errors and Omissions insurance? is Required

Yes No

Has there been a claim against you in the past seven years?:* Has there been a claim against you in the past seven years? is Required

Yes No