Patient Care Advocate - 730650

Davita Inc.; Raleigh (NC); Remote; USD 45,000 - 60,000; Full time

Job summary

A leading healthcare organization is seeking a Patient Care Advocate for a remote position. The role involves collaborating with members and providers to enhance healthcare access and quality, while ensuring compliance with HEDIS measures. Applicants should have a Bachelor’s degree in a related field and relevant experience in patient care or health coaching.

Qualifications

• Minimum of 4 years of experience in direct patient care, social work, or health coaching.
• Preferred licenses include RN, LPN, LMSW, LSW.
• At least 2 years of experience in a managed care environment preferred.

Responsibilities

• Acts as liaison and member advocate between members and providers.
• Educates provider practices on HEDIS measures and coding.
• Conducts telephonic outreach and face-to-face member education.

Skills

Member outreach experience

HEDIS knowledge

Education

Bachelor's Degree in Healthcare or related field

Job description

Position Title: Patient Care Advocate

Work Location: Remote, PST preferred

Assignment Duration: 6 Months

Work Schedule: 8-5 PST, 1 hour lunch break

Work Arrangement: Remote



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.


• 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.


• Conducts telephonic outreach, while embedded in the providers' offices, to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements.


• Provides education to members regarding the care gaps they have when in the providers office for medical appointments.


• Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available.


• Maintains confidentiality of business and protected health information.

Background & Context:

• Increased membership leading to need for additional worker.

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.

Qualification & Experience:

• Required A 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).


• Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.


• 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.


• One of the following is preferred: Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.

Candidate Requirements
Required: Associate or Bachelor's Degree	Preferred:
Required: i.e RN, BSN, LPN,	Preferred:
Years of experience required Disqualifiers Best vs. average Performance indicators	Must haves: Member outreach experience. Nice to haves: HEDIS Disqualifiers: Performance indicators: Track calls on number of members called and success rate.