Patient Care Advocate

• 
  

  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:

• 
  

  This role will provide an opportunity for direct, face-to-face engagement with members and providers.

  
  
• 
  

  It offers the opportunity to work onsite with providers to assist with engaging members and helping them navigate the healthcare system.

  
  
• 
  

  Offers a unique role that bridges the gap between health plans and providers, improving communication and alignment.

  
  
• 
  

  Embedding in provider offices creates a dynamic work environment

  
  
  

  Candidate Requirements
  Education/Certification	Required: 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)	Preferred: Will take RN/LPN with 4 years' experience in lieu of bachelor's degree. (Can have Associate's degree)
  Licensure	Required: RN, BSN, or LPN	Preferred: Licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN)
  Years of experience required Disqualifiers Best vs. average Performance indicators	Must haves: 4 years of experience in lieu of degree. RN or LPN with outpatient provider practice experience strongly preferred. Nice to haves: Knowledge of HEDIS/Preventive screening recommendations Disqualifiers: Not willing to travel/perform field work Performance indicators: HEDIS care gap closure rates, HEDIS measure improvement, member outreach success rate, appointment scheduling rate, provider engagement/satisfaction
  Top 3 must-have hard skills Level of experience with each Stack-ranked by importance Candidate Review & Selection	1	Communication and Interpersonal Skills
  2	Understanding of Provider Practice Scheduling
  3	Problem Solving and Resource Coordination