Patient Care Advocate

Summary:

• Work Mode: Remote and Member facing
• Location: Candidate must live within Kent County and New Castle County and be willing to travel up to 2.5 hours from home address. Mileage will be reimbursed.
• Duration: 3 months with possible extension or conversion based on performance
• Mon-Fri, 8am-5pm EST, no weekends or holidays, no OT

Responsibilities:

• Act as a liaison and member advocate between the member/family, physician, and facilities/agencies.
• Serve as the face of the company in the provider community with the provider and office staff where services are embedded.
• Advise and educate Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
• Assess provider performance data to identify and strategize opportunities for provider improvement.
• Collaborate with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).
• Schedule doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office.
• Conduct face-to-face education with the member and their family, in the provider’s office, about care gaps identified, and barriers to care.
• Conduct telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
• Arrange transportation and follow-up appointments for members as needed.
• Document all actions taken regarding contact related to members.
• Interact with other departments including customer service to resolve member issues.
• Refer to case or disease management as appropriate.
• Complete special assignments and projects instrumental to the function of the department.
• Perform other duties as assigned.

Requirements:

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position).
• Minimum 2 years of experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.

Preferred Skills:

• Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.
• Excellent customer service skills.
• Experience with member and/or patient outreach and care gap closure (telephonic and/or in-person).
• Familiarity with Medicaid, Medicare Advantage, or dual populations.