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Patient Care Advocate

Company: Actalent
Location: Manchester
Posted on: November 19, 2023

Job Description:

Description:"Position Purpose: 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 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.* Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.* 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).* 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.Education/Experience: Required* A 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).* Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.If interested in this remote opportunity, please apply and reach out directly to Stephanie Lipari at slipari@, Equity & InclusionAt Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:* Hiring diverse talent* Maintaining an inclusive environment through persistent self-reflection* Building a culture of care, engagement, and recognition with clear outcomes* Ensuring growth opportunities for our peopleActalent is an equal opportunity employer.About ActalentActalent connects passion with purpose. We help visionary companies advance their engineering and science initiatives through access to specialized experts that drive scale, innovation, and speed to market. With a network of almost 30,000 engineering and sciences consultants and more than 4,500 clients across the U.S., Canada, Asia, and Europe, Actalent serves many of the Fortune 500. An operating company of Allegis Group, the global leader in talent solutions, Actalent launched as a new specialized engineering and sciences services and workforce solutions brand in 2021.

Keywords: Actalent, Manchester , Patient Care Advocate, Other , Manchester, New Hampshire

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