Patient Care Advocate

Position Title: Patient Care Advocate

Work Location: Remote

Duration: 12 Months

Work Schedule: 8-5 (CST) M-F; 40 hours/week; no OT

Position Summary: Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. Acts as the face of the 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.
• Performs other duties as assigned
• Complies with all policies and standards

• *Required: *Bachelor's Degree
• 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.
• Required: i.e. RN, BSN, LPN
• a total of 4 years of experience required for the position
• Skill: HEDIS Knowledge/Awareness - Level of experience: 5/5
• Clinical Knowledge - 4.75 / 5
• Communication Skills - 4 .5 / 5