Clinical - Patient Care Advocate

Position Title:

Patient Care Advocate

Location:

Remote

Schedule:

Mon-Fri 8am-5pm ESTDuration: 3 Months (Possibility of Extension and Conversion)
PR: XXXXXXXXXXX to XXXXXXXXXXX2/hr summary

Focuses on improving HEDIS performance, strengthening provider partnerships, and enhancing the member experience by reducing barriers to care. We have high volume of members with open care gaps requiring targeted outreach and appointment scheduling. These roles will help close care gaps and improve quality outcomes. Flexible and collaborative, with opportunities for candidates to work independently while making a meaningful impact on member health outcomes.

• Conducts telephonic outreach to members and coordinates with the provider community to schedule routine appointments (Annual Preventive Visits, Diabetic Eye Exams, Mammograms, Colonoscopies, etc.)
• Educates members on the importance of routine screenings.
• Research member claims, care gaps, and outreach history prior to conducting outbound calls.
• Assists members with wraparound services such as translation, transportation, or referrals for other value-added benefits as needed.
• Document outreach outcomes within designated tools.
• Performance metrics:
  Members reached/engaged, Appointments Scheduled, Care Gaps closed

• 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)
• 2 years. Work experience should be in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.

• RN, LPN, LMSW, LSW, Certified Social Worker

• 30-50 inbound and outbound calls per day experience

• 1
• Excellent customer service skills
• 2
• Member and/or patient outreach and care gap closure (telephonic and/or in-person)
• 3
• Familiarity with Medicaid, Medicare Advantage, or dual populations