Patient Care Advocate

Spectraforce Technologies; Newark (DE); On-site; USD 42,000 - 62,000; Full time

Job summary

Spectraforce Technologies is seeking a Patient Care Advocate to work onsite in Newark, DE. The role focuses on closing care gaps, educating providers on HEDIS measures, and improving member and provider experiences through face-to-face outreach.

Responsibilities include coordinating care with providers, scheduling preventive visits, and conducting health coaching to support quality improvement and regulatory requirements in a managed care environment.

Qualifications

• Bachelor's degree or equivalent required in a healthcare-related field.
• Minimum 2 years of direct patient care, social work, quality improvement or health coaching experience.
• Preferred RN, LPN, LMSW, LSW, or Certified Social Worker licensure or equivalent.
• Experience in managed care settings is a plus.

Responsibilities

• Acts as a liaison between member/family, physician, and facilities.
• Represents the organization in provider communities embedded in provider offices.
• Educates providers on HEDIS measures and coding per NCQA requirements.
• Assesses provider performance data to identify improvement opportunities.
• Collaborates with Provider Relations to enhance quality, risk adjustment, and claims/encounters.
• Schedules appointments for members with care gaps to access preventive care.
• Conducts face-to-face member education in providers' offices about gaps and barriers to care.
• Performs telephonic outreach and health coaching to support quality improvement and regulatory requirements.
• Arranges transportation and follow-up appointments as needed.
• Documents all member-related actions and interacts with customer service to resolve issues.

Skills

Excellent customer service

Member outreach

Care gap closure

Health coaching

Medicaid/Medicare knowledge

Education

Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related field

Job description

Position Title: Patient Care Advocate

Work Location: Newark, DE, 19713

Assignment Duration: 3 months (possibility to extend or convert)

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

Work Arrangement: Onsite (embedded in provider offices 5 days a week)

Position Summary

Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding.

Background & Context

Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS.

Key Responsibilities

• Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
• Acts as the face of our 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.
• Will work at provider offices in Kent County and New Castle County 5 days a week.

Education/Certification

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)

Preferred:

Licensure

Required: NA

Preferred: RN, LPN, LMSW, LSW, Certified Social Worker

Years of Experience

Years of experience required: 2 years. Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.

Additional qualities to look for

• Top 3 must-have hard skills stack-ranked by importance
• 1. Excellent customer service skills
• 2. Member and/or patient outreach and care gap closure (telephonic and/or in-person)
• 3. Familiarity with Medicaid, Medicare Advantage, or dual populations