Patient Care Advocate

  • location: Little Rock, AR
  • type: Contract
  • salary: $21.80 per hour
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job description

Patient Care Advocate

job summary:
Description:

JOB SUMMARY

    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 medial 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.
ESSENTIAL FUNCTIONS

Key Duties and Responsibilities

    Acts as a liaison and member advocate between the member/family, physician and facilities/agenciesActs as the face of Client in the provider community with the providers' and offices staff where their services are embedded 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, 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, regulatory and contractual requirements. 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.
Additional Position Responsibilities

    Located in a provider?s office.
MINIMUM QUALIFICATIONS ---- A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field. Required

Work Experience

    2+ years of experience in HEDIS, quality improvement, member outreach and/or health coaching in a managed care environment Required2+ years of experience in Social work experience Preferred Other Experience in managed care Preferred
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred ---- Other One of the below is preferred PreferredLicensed Clinical Social Worker (LCSW) PreferredLicensed Social Worker (LSW) PreferredCertified Social Worker (C-SW) PreferredCertified Social Worker in Health Care (C-SWHC) PreferredLicensed Clinical Social Worker Certified (LCSW-C) Preferred

Skills

    Demonstrated interpersonal/verbal communication skills Intermediate Demonstrated written communication skills Intermediate Ability to create, review and interpret treatment plans Intermediate Ability to effectively present information and respond to questions from families, members, and providers Intermediate Ability to multi-task Intermediate Ability to work in a fast paced environment with changing priorities Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Intermediate Knowledge of healthcare delivery Intermediate Knowledge of community, state and federal laws and resources Beginner Other Data Entry skills Intermediate Other Appreciation and sensitivity towards cultural diversity and targeted populations Intermediate Other Ability to work independently with minimal supervisor Advanced Other Ability to organize and prioritize own work in order to meet goals
Advanced ---- Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred ---- Microsoft Word Proficient in Microsoft Office such as Word, Excel and Outlook Intermediate

Required Microsoft Excel Ability to use and navigate health service management systems Intermediate

Required Microsoft Outlook Intermediate

Required Healthcare Management Systems (Generic) Intermediate Required

Languages ---- List all that apply ---- Languages Other Languages Required/Preferred ---- Spanish Preferred

SCOPE ---- Level of Supervision Received: ---- A statement which describes the level of independence for this position. ---- [X] Functions independently within broad scope of established departmental policies/practices; generally refers specific problems to supervisor only where clarification of departmental operating policies/procedures may be required. ---- Level of Supervision Exercised: ---- (Select all that apply) Positions Supervised ---- [X] Individual Contributor 1 [ ] (Please check all that apply) ---- Impact: ---- A statement which describes the impact to the company regarding contributions, decisions, recommendations or actions taken by the incumbent. ---- [X] Failure to achieve results or erroneous judgments may require the allocation of additional resources to correct and / or achieve goals. ---- Problem Complexity: ---- A statement which describes how clearly a problem is defined when presented, how much additional effort is required to understand the nature of the problem and the typical timescales for resolution. ---- [X] Provides resolution to an assortments of problems that are typically well defined, but some clarification or judgment is needed to proceed. Uses judgment within defined practices / procedures to determine appropriate action.

 
location: Little Rock, Arkansas
job type: Contract
work hours: 8 to 5
education: Bachelor's degree
experience: 2 Years
 
responsibilities:
    Acts as a liaison and member advocate between the member/family, physician and facilities/agenciesActs as the face of Client in the provider community with the providers' and offices staff where their services are embedded 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, 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, regulatory and contractual requirements. 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.
 
qualifications:
A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field. Required

Work Experience

    2+ years of experience in HEDIS, quality improvement, member outreach and/or health coaching in a managed care environment Required2+ years of experience in Social work experience Preferred Other Experience in managed care Preferred
Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred ---- Other One of the below is preferred PreferredLicensed Clinical Social Worker (LCSW) PreferredLicensed Social Worker (LSW) PreferredCertified Social Worker (C-SW) PreferredCertified Social Worker in Health Care (C-SWHC) PreferredLicensed Clinical Social Worker Certified (LCSW-C) Preferred

Skills

    Demonstrated interpersonal/verbal communication skills Intermediate Demonstrated written communication skills Intermediate Ability to create, review and interpret treatment plans Intermediate Ability to effectively present information and respond to questions from families, members, and providers Intermediate Ability to multi-task Intermediate Ability to work in a fast paced environment with changing priorities Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records Intermediate Knowledge of healthcare delivery Intermediate Knowledge of community, state and federal laws and resources Beginner Other Data Entry skills Intermediate Other Appreciation and sensitivity towards cultural diversity and targeted populations Intermediate Other Ability to work independently with minimal supervisor Advanced Other Ability to organize and prioritize own work in order to meet goals
 
skills: Other:
Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

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