Position Title: Patient Care Advocate

Work Location: Remote, EST (preferably residing within Delaware). Open to candidates in EST timezone

Assignment Duration: 3 months, with potential to extend or convert

Work Schedule: Mon - Fri 8 a.m. – 5 p.m. EST. No weekends or holidays. No OT

Work Arrangement: Remote, EST time zone required; Delaware residency preferred

Position 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.

Background & Context: This team is focused on three core initiatives: improving HEDIS performance, strengthening provider partnerships, and enhancing the member experience by reducing barriers to care. The plan has a high volume of members with open care gaps who need targeted outreach to schedule appointments. The work environment is flexible and collaborative; contractors work independently while driving measurable health outcomes. Additional embedded-in-practice seats are expected later; this assignment is the remote outreach seat.

Key Responsibilities:

• Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
• Acts as the face of our organization in the provider community with the provider and office 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 strategizes 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 and 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
• Complies with all policies and standards
• 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.

Qualification & Experience:

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:
Licensure	Required: NA			Preferred: RN, LPN, LMSW, LSW, Certified Social Worker
Years of experience required: 2 years. Work experience should be in direct patient care, social work, quality improvement or health coaching, preferably in a managed care environment.   Disqualifiers:   Additional qualities to look for: 30-50 inbound and outbound calls per day experience
Top 3 must-have hard skills stack-ranked by importance		1	Excellent customer service skills
		2	Member and/or patient outreach and care gap closure (telephonic and/or in-person)
		3	Familiarity with Medicaid, Medicare Advantage, or dual populations

 
 
At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $28.00/hr - $30.00/hr.