Patient Care Advocate

Summary: Work Mode: Remote and Member facing Location: Candidate must live within Kent County and New Castle County and be willing to travel up to 2.5 hours from home address. Mileage will be reimbursed. Duration: 3 months with possible extension or conversion based on performance Mon-Fri, 8am-5pm EST, no weekends or holidays, no OT Responsibilities: Act as a liaison and member advocate between the member/family, physician, and facilities/agencies. Serve as the face of the company in the provider community with the provider and office staff where services are embedded. Advise and educate Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements. Assess provider performance data to identify and strategize opportunities for provider improvement. Collaborate with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters). Schedule doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider's office. Conduct face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care. Conduct telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements. Arrange transportation and follow-up appointments for members as needed. Document all actions taken regarding contact related to members. Interact with other departments including customer service to resolve member issues. Refer to case or disease management as appropriate. Complete special assignments and projects instrumental to the function of the department. Perform other duties as assigned. Requirements: 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). Minimum 2 years of experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment. Preferred Skills: Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred. Excellent customer service skills. Experience with member and/or patient outreach and care gap closure (telephonic and/or in-person). Familiarity with Medicaid, Medicare Advantage, or dual populations. Axelon