Patient Care Advocate

Position Title: Patient Care Advocate

Work Location: Remote - Pacific time zone (must work PST hours)

Assignment Duration: 8 Months

Work Schedule: 8 hours per day. No overtime

Work Arrangement: Remote

Position Summary:

Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and telephonic interaction.

Serves to collaborate with providers to improve HEDIS measures and provide education for HEDIS measures and coding.

Background & Context:

The team's purpose is to make outreach calls to members, educate them on the importance of preventative care and screenings, address all member needs, and create positive experiences. Backfill role.

Key Responsibilities:

• Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
• Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
• Assesses provider performance data to identify and strategizes opportunities for provider improvement.
• Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
• Schedules doctor appointments for members with care gaps to access needed preventive care services.
• Conducts education with the member and their family about care gaps identified and barriers to care.
• Conducts telephonic outreach and health coaching to members.
• Arranges transportation and follow-up appointments for member as needed.
• Documents all actions taken regarding contact related to member.
• Interacts with other departments including customer service to resolve member issues.
• Refers to case or disease management as appropriate.
• Completes special assignments and projects instrumental to the function of the department.
• Performs other duties as assigned.
• Complies with all policies and standards.
  
  
  
  
  
  

  Education/Certification	Bachelor's Degree in Healthcare/ Public Health/ Nursing/Psychology/ Social Work/ Health Administration, or related health field or equivalent work experience	Preferred: See below
  Licensure	Required: N/A	Preferred: one of the following: Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN)
  Years of experience required: 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching, preferably in a managed care environment. Disqualifiers: Additional qualities to look for: Member outreach experience. HEDIS knowledge.
  Top 3 must-have hard skills stack-ranked by importance	1	The ability to work effectively in a remote environment while remaining self-motivated and driven to meet or exceed established goals and deliver measurable results. Self-discipline and time management.
  2	Previous experience in a role handling a high volume of outbound calls.
  3	Ability to learn and adapt to new systems and company changes