What are the responsibilities and job description for the Patient Care Advocate position at Actalent?
Description:
"Position Purpose: 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 provider's office for medical appointments. Schedules doctor appointments on behalf of the practitioner and assists members with wraparound services such as arranging transportation, and connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information.
"Acts as a liaison and member advocate between the member/family, physician, and facilities/agencies.
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 strategize opportunities for provider improvement.
Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, and 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 and regulatory and contractual requirements.
Arranges transportation and follow-up appointments for the member as needed.
Documents all actions taken regarding contact related to members.
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."
Education/Experience: 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 is 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,
License/Certification: 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."
Skills:
Health care, Data entry, Insurance, Medical, data entry software, HEDIS Measures, patient education, Inbound and outbound calls, Member Outreach, Patient Care, Refereals, Collections customer service, Collection
Top Skills Details:
Health care, Data entry, Insurance, Medical, data entry software, HEDIS Measures, patient education, Inbound and outbound calls, Member Outreach, Patient Care
Additional Skills & Qualifications:
License/Certification (Preferred): 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."
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
Actalent is an equal opportunity employer.
About Actalent
Actalent connects passion with purpose. We help visionary companies advance their engineering and science initiatives through access to specialized experts that drive scale, innovation, and speed to market. With a network of almost 30,000 engineering and sciences consultants and more than 4,500 clients across the U.S., Canada, Asia, and Europe, Actalent serves many of the Fortune 500. An operating company of Allegis Group, the global leader in talent solutions, Actalent launched as a new specialized engineering and sciences services and workforce solutions brand in 2021.
Salary : $20 - $27
