Patient Care Advocate
Core
Works with members and providers to close care gaps, remove barriers to care, and improve member/provider experience through face-to-face interaction and outreach.
Role type
Patient Care Advocate (Healthcare Operations)
Builds
Member engagement and provider quality improvement initiatives
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
HEDIS measures knowledge, ICD-10/CPT coding, care gap identification, telephonic outreach, health coaching, transportation coordination, community resource navigation, data assessment, provider relations collaboration
Preferred skills
Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), Licensed Registered Nurse (RN), Spanish fluency
Technologies
HEDIS, ICD-10, CPT
Responsibilities
Conduct face-to-face education with members and families regarding care gaps; schedule doctor appointments for members with care gaps; arrange transportation and follow-up appointments; conduct telephonic outreach and health coaching; advise and educate provider practices on HEDIS measures and coding; assess provider performance data to strategize improvements; collaborate with Provider Relations on quality and risk adjustment; document all member contact actions; refer members to case or disease management as appropriate.
Seniority
Mid-level, hands-on IC