GDMT Health Advocate-Atrium Health-FT

Essential Functions Actively engages a population of medically vulnerable or chronically ill patients in their care, providing support, encouragement, and education to help them achieve better health outcomes. Communicates with patients and caregivers in person, in groups, by telephone, and electronically. Monitors patient-reported biometrics, medication adherence, challenges, and barriers, connecting patients with appropriate resources or notifying the clinical care team when follow-up is needed. Advocates for and facilitates referrals to services and resources, including patient assistance programs, community-based services, and mental health support. Assists provider offices with missed appointments through patient outreach and scheduling. Provides customized, evidence-based patient education, including weight management, exercise, tobacco cessation, stress reduction, and chronic disease self-management. Supports patients who frequently utilize inappropriate levels of care by providing education and connecting them with appropriate healthcare resources. Serves as a first point of contact for Heart Failure patients , including triaging questions and escalating clinical concerns as appropriate. Screens Heart Failure referrals according to established protocols and conducts initial patient outreach. Educates newly referred patients on the Heart Failure program, gathers necessary patient information, and assists with scheduling initial appointments. Provides patient follow-up after visits to confirm medications have been obtained, identify barriers, and reinforce the plan for follow-up care. Supports remote blood pressure monitoring by ordering and shipping blood pressure cuffs, educating patients on proper use, monitoring reported readings, and escalating concerns to the clinical team. Provides Guideline-Directed Medical Therapy (GDMT) patient education. Assists with prior authorizations, patient assistance programs, lab rescheduling, and relevant external grant applications . Collaborates with social work, pharmacy, providers, and other members of the interdisciplinary care team to address patient needs. Provides administrative support, including data tracking, patient outreach documentation, and task management . Performs additional responsibilities as needed. Physical Requirements Work may occur in a variety of settings, including office, clinic, school, or other community setting. Requires walking, standing, sitting, lifting, reaching, bending, pushing and pulling. Must be able to lift and support the weight of 50 pounds in handling equipment and supplies. Must have intact sense of sight, hearing, smell, touch and finger dexterity. Must be able to move about the medical center and to travel to various clinical and community locations. Education, Experience and Certifications High School diploma or equivalent required. #J-18808-Ljbffr Advocate Aurora Health