Immediate need for a talented Patient Care Advocate. This is a 03+months contract opportunity with long-term potential and is located in Delaware State (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-27640
Pay Range: $24 - $28/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Act as a liaison and member advocate between members/families, physicians, facilities, and community agencies
- Build relationships with provider practices and office staff
- Educate provider practices on applicable HEDIS measures and HEDIS ICD-10/CPT coding requirements
- Review provider performance data and identify opportunities for improvement
- Collaborate with internal teams to improve provider performance across quality, risk adjustment, claims, and encounter-related areas
- Conduct telephonic outreach to members with identified care gaps
- Coordinate and schedule preventive healthcare appointments, including Annual preventive visits, Diabetic eye exams, Mammograms, Colonoscopies and other routine screenings
- Educate members and their families on the importance of preventive screenings and recommended care
- Research member claims, care gaps, and previous outreach activity before conducting outbound calls
- Identify and address barriers preventing members from obtaining needed care
- Arrange transportation and follow-up appointments when needed
- Assist members with wraparound services, including translation, transportation, community resources, and other available benefits.
- Provide health coaching to members
- Document all member outreach and actions taken in designated systems
- Work with departments such as Customer Service to resolve member issues
- Refer members to case management or disease management when appropriate
- Complete special projects and other duties as assigned
- Maintain confidentiality of business information and protected health information
- Comply with applicable policies, procedures, and standards
- Typical activities include:
- Making approximately 30-50 inbound/outbound calls per day
- Contacting members who need preventive or chronic-care services
- Scheduling appointments with provider offices
- Educating members about recommended screenings and preventive care
- Reviewing claims, care-gap information, and prior outreach history
- Helping members overcome logistical barriers such as transportation or language needs
- Documenting outreach results and appointment outcomes
Key Requirements and Technology Experience:
- Must have skills: Patient/Member Outreach experience
- Experience with Care Gap Closure
- Experience with Medicaid / Medicare Advantage / Managed Care
- Bachelor s degree in healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related healthcare field, or equivalent work experience.
- Approximately 4 years of total relevant education/work experience, with at least 2 years of relevant experience in: Direct patient care, Social work, Quality improvement, Health coaching
- Experience in a managed care environment is preferred
- Strong customer service and communication skills
- Experience with member/patient outreach and care-gap closure through telephone and/or in-person interactions
- Familiarity with Medicaid, Medicare Advantage, or dual-eligible populations
- Ability to handle a high volume of inbound and outbound call
- High School Diploma or GED
Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
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