Patient Care Advocate
About The Position
SUMMARY: Works with members and providers to close care gaps, assist with medication refills, identify barriers to care, and improve the overall member and provider experience through outreach with members and providers. Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and provides education to members regarding the care gaps they have. Assist with scheduling doctor appointments on behalf of the member and assists 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. Reports to: Manager, Quality & Strategy Engagement Location: Houston, TX EDUCATION: Bachelors or Associates Degree in related field or two (2) years related experience LICENSES/CERTIFICATIONS: A license in one of the following is preferred: Pharmacy Technician (CPhT) Licensed Vocational Nurse (LVN) Registered Nurse (RN) Social Worker (LSW) EXPERIENCE: Work experience should be in direct patient care, social work, quality improvement or health coaching preferable in a managed care environment. Knowledge of CMS STAR Ratings Program requirements preferred. Knowledge of HEDIS and NCQA requirements preferred. SKILLS: Knowledge of healthcare delivery Strong oral communication skills Ability to work in a fast paced environment with changing priorities Ability to work with others in a matrixed environment Demonstrated written communication skills Demonstrated time management and priority setting skills Demonstrated problem solving skills Demonstrated organizational skills
Requirements
- Bachelors or Associates Degree in related field or two (2) years related experience
- Work experience should be in direct patient care, social work, quality improvement or health coaching preferable in a managed care environment.
- Knowledge of healthcare delivery
- Strong oral communication skills
- Ability to work in a fast paced environment with changing priorities
- Ability to work with others in a matrixed environment
- Demonstrated written communication skills
- Demonstrated time management and priority setting skills
- Demonstrated problem solving skills
- Demonstrated organizational skills
- Working knowledge of Microsoft Office
- Working knowledge of Electronic Health Records (EHR)
Nice To Haves
- A license in one of the following is preferred: Pharmacy Technician (CPhT) Licensed Vocational Nurse (LVN) Registered Nurse (RN) Social Worker (LSW)
- Knowledge of CMS STAR Ratings Program requirements preferred.
- Knowledge of HEDIS and NCQA requirements preferred.
Responsibilities
- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
- Schedules doctor appointments for members with care gaps to access needed preventive care services
- Conducts telephonic outreach to members at risk for medication non-adherence and provides assistance as needed with obtaining medication refills.
- Conducts telephonic outreach to members and providers to support quality improvement & risk adjustment initiatives
- Arranges transportation for members as needed.
- Arranges 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.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
Associate degree
