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 (Field-based)
Builds
Member care access and provider quality improvement initiatives
Domain
Healthcare / Managed Care
Deliverable
physical/clinical work
Required skills
Direct patient care, social work, quality improvement, health coaching, HEDIS measures, ICD-10/CPT coding, care gap identification, transportation coordination, community resource connection
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 in provider offices; schedule doctor appointments for members with care gaps; conduct telephonic outreach and health coaching; arrange transportation and follow-up appointments; 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.
Seniority
Mid-level, hands-on IC