Patient Care Advocate

This is a Fully Remote Job
About Our Client:
The organization operates within the managed care and health services industry, focusing on connecting individuals to necessary healthcare to support healthier lives. It addresses challenges in healthcare accessibility and quality by collaborating with providers and members to improve care continuity and outcomes. The program supports compliance with state and federal standards and emphasizes quality improvement through provider education and data-driven strategies.
About the Opportunity:
The PATIENT CARE ADVOCATE role is designed to close care gaps by working directly with members and healthcare providers. This position plays a critical role in enhancing member and provider experiences by facilitating access to preventive services, educating on care measures, and coordinating care efforts. The advocate supports quality initiatives and regulatory compliance by bridging communication between members, providers, and care teams.
Responsibilities:
Collaborate with members and providers to close care gaps and remove barriers to care
Provide education on HEDIS measures and coding to providers
Support quality improvement interventions and provider audits
Conduct telephonic outreach and face-to-face education with members at provider offices
Schedule medical appointments and assist members with wraparound services such as transportation and community resources
Maintain confidentiality of business and protected health information
Act as a liaison and advocate between members, families, physicians, and facilities
Assess provider performance data and strategize improvement opportunities
Work with Provider Relations to enhance performance in quality, risk adjustment, and operations
Document all member contact and actions
Coordinate with other departments to resolve member issues
Refer members to case or disease management as appropriate
Complete special assignments and comply with all policies and standards
Requirements:
Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related field, or equivalent experience totaling four years
Minimum of 2 years of experience in direct patient care, social work, quality improvement, or health coaching, preferably in managed care
Preferred certifications: Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN)
For Michigan plans, a valid driver's license is required
Pay Range and Compensation Package:
$27.02 - $48.55 per hour
Benefits & Perks:
Health insurance
401(k) plan
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.