Patient Care Advocate

Location: Delaware First Health

Responsibilities:

• Work with members and providers to close care gaps and remove barriers to care.
• Enhance the overall member and provider experience through outreach and face-to-face interaction at large IPA and/or group practices.
• Collaborate with providers to improve HEDIS measures and provide education on HEDIS measures and coding.
• Support the implementation of quality improvement interventions and audits related to plan providers.
• Resolve deficiencies impacting plan compliance with State and Federal standards for HEDIS.
• Conduct telephonic outreach, while embedded in providers' offices, to members needing preventive services.
• Educate members regarding care gaps during medical appointments.
• Schedule doctor appointments and assist members with wraparound services such as arranging transportation and connecting with community-based resources.
• Maintain confidentiality of business and protected health information.
• Act as a liaison and member advocate between the member/family, physician, and facilities/agencies.
• Advise and educate provider practices on appropriate HEDIS measures and ICD-10/CPT coding.
• Assess provider performance data to identify and strategize opportunities for improvement.
• Collaborate with Provider Relations to enhance provider performance in Quality, Risk Adjustment, and Operations.
• Conduct face-to-face education with members and their families about care gaps and barriers to care.
• Document all actions taken regarding contact related to members.
• Interact with other departments, including customer service, to resolve member issues.
• Refer cases to disease management as appropriate.
• Complete special assignments and projects instrumental to the department's function.
• Comply with all policies and standards.

Requirements:

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field, or equivalent work experience.
• Minimum 4 years of experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.
• Minimum 2 years of experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.

Preferred Skills:

• Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN) preferred.