Clinical - Patient Care Advocate - 730650

Job Title: Patient Care Advocate

Duration: 3 Months (Potential Extension and Conversion to FTE)

Location: Newark, DE 19713

Work Schedule: Mon-Fri | 8 a.m. 5 p.m. EST, No weekends or holidays, No OT

PR: XXXXXXXXXXX/HR

Day to Day Responsibilities:

• Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.

• Acts as the face 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 strategize 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.

• Will work at provider offices in Kent County and New Castle County 5 days a week

Required:

• 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.

Preferred

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

Skills:

• Excellent customer service skills

• Member and/or patient outreach and care gap closure (telephonic and/or in-person)

• Familiarity with Medicaid, Medicare Advantage, or dual populations