Immediate need for a talented
Patient Care Advocate. This is a
03 months contract opportunity with long-term potential and is located in
Delaware State (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-27640
Pay Range: $24 - $28/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:- Act as a liaison and member advocate between members/families, physicians, facilities, and community agencies
- Build relationships with provider practices and office staff
- Educate provider practices on applicable HEDIS measures and HEDIS ICD-10/CPT coding requirements
- Review provider performance data and identify opportunities for improvement
- Collaborate with internal teams to improve provider performance across quality, risk adjustment, claims, and encounter-related areas
- Conduct telephonic outreach to members with identified care gaps
- Coordinate and schedule preventive healthcare appointments, including Annual preventive visits, Diabetic eye exams, Mammograms, Colonoscopies and other routine screenings
- Educate members and their families on the importance of preventive screenings and recommended care
- Research member claims, care gaps, and previous outreach activity before conducting outbound calls
- Identify and address barriers preventing members from obtaining needed care
- Arrange transportation and follow-up appointments when needed
- Assist members with wraparound services, including translation, transportation, community resources, and other available benefits.
- Provide health coaching to members
- Document all member outreach and actions taken in designated systems
- Work with departments such as Customer Service to resolve member issues
- Refer members to case management or disease management when appropriate
- Complete special projects and other duties as assigned
- Maintain confidentiality of business information and protected health information
- Comply with applicable policies, procedures, and standards
- Typical activities include:
- Making approximately 30-50 inbound/outbound calls per day
- Contacting members who need preventive or chronic-care services
- Scheduling appointments with provider offices
- Educating members about recommended screenings and preventive care
- Reviewing claims, care-gap information, and prior outreach history
- Helping members overcome logistical barriers such as transportation or language needs
- Documenting outreach results and appointment outcomes
Key Requirements and Technology Experience:- Must have skills: Patient/Member Outreach experience
- Experience with Care Gap Closure
- Experience with Medicaid / Medicare Advantage / Managed Care
- Bachelor’s degree in healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related healthcare field, or equivalent work experience.
- Approximately 4 years of total relevant education/work experience, with at least 2 years of relevant experience in: Direct patient care, Social work, Quality improvement, Health coaching
- Experience in a managed care environment is preferred
- Strong customer service and communication skills
- Experience with member/patient outreach and care-gap closure through telephone and/or in-person interactions
- Familiarity with Medicaid, Medicare Advantage, or dual-eligible populations
- Ability to handle a high volume of inbound and outbound call
- High School Diploma or GED
Our client is a leading
Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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