Patient Care Advocate

Patient Care Advocate

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).

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