Patient Care Advocate

Position Title: Patient Care Advocate

Work Location: Remote, PST preferred

Assignment Duration: 6 Months

Work Schedule: 8-5 PST, 1 hour lunch break

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 face-to-face interaction with members and providers at large IPA and/or group practices.
• Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding.
• Supports the implementation of quality improvement interventions and audits in relation to plan providers.
• Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS.
• Conducts telephonic outreach, while embedded in the providers' offices, to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements.
• Provides education to members regarding the care gaps they have when in the providers office for medical appointments.
• Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available.
• Maintains confidentiality of business and protected health information.

Background & Context:

• Increased membership leading to need for additional worker.

Key Responsibilities:

• Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
• Acts as the face of our organization in the provider community with the provider and office staff where their services are embedded.
• 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 and close gaps in care in the provider's office.
• Conducts face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care.
• Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
• 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.

Qualification & Experience:

• Required A 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).
• Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.
• 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.
• One of the following is preferred: Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.