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Position Title: Patient Care Advocate
Work Location: Eugene Area, Oregon (OR)
Assignment Duration: 2 Months
Work Schedule: Monday–Friday, with potential evening and weekend hours (PST)
Work Arrangement: Field-Based / Member-Facing (Not Remote; Not at a Client Facility)
The Patient Care Advocate works directly with members and healthcare providers to close care gaps, remove barriers to care, and improve the overall member and provider experience through outreach and face-to-face interactions. This role involves working within large IPA and/or group practices, collaborating with providers to improve HEDIS performance, and providing education on HEDIS measures and appropriate coding practices.
The role supports a limited, outcome-based Member Navigation Program for identified Oregon Medicare members with verified open gaps in specific HEDIS measures. The primary objective is to improve HEDIS gap closure through after-hours outreach, direct appointment scheduling, appointment reminders, referral navigation, and verified completion tracking, supported by expanded-hours appointment access.
Act as a liaison and member advocate between members, their families, physicians, healthcare facilities, and community agencies.
Represent the organization within the provider community, serving as its primary point of contact with providers and office staff at assigned practices.
Educate provider practices on appropriate HEDIS measures and HEDIS-related ICD-10/CPT coding in accordance with NCQA requirements.
Review provider performance data to identify improvement opportunities and develop strategies to enhance performance.
Collaborate with Provider Relations to improve provider performance in Quality, Risk Adjustment, and Operations (claims and encounters).
Schedule physician appointments for members with identified care gaps to ensure access to necessary preventive care services.
Conduct face-to-face education with members and their families in provider offices regarding identified care gaps and potential barriers to care.
Perform telephonic outreach and health coaching to support quality improvement and regulatory and contractual requirements.
Coordinate transportation and follow-up appointments for members as needed.
Maintain accurate documentation of all member-related outreach and actions taken.
Collaborate with other departments, including Customer Service, to resolve member issues.
Refer members to Case Management or Disease Management programs when appropriate.
Complete special assignments and projects that support departmental objectives.
Perform other duties as assigned. Comply with all organizational policies, procedures, and standards.
| Education/Certification | Required: High School Education | Preferred: Certification in Healthcare | ||
| Licensure | Required: None | Preferred: CNA/MA/RN | ||
| Years of experience required: 3 Disqualifiers: Additional qualities to look for: | ||||
| 1 | Patient care experience, front of clinic or back of clinic okay, HIPAA training | ||
| 2 | Ability to flex between groups | |||
| 3 | Live in area assigned | |||