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The Care Advocate is a non-clinical position that assists the clinical staff in supporting members with acute and chronic clinical conditions.
Essential Duties and Responsibilities:
•Maintains and ensures the confidentiality of all Personal Health Information (PHI) collected
•Serves as a member advocate, providing support, triage and referral access to the clinical staff for resolution of member concerns, complaints and grievances
•Participates in all client specific program, process and quality training programs
•Enters new cases in the Care Management System for the nursing review staff through telephonic collection of demographic member specific data maintaining accuracy and quality of data
•Obtains a Health Risk Assessment through a scripted tool on members in accordance with client process requirements
•Places outreach calls to remind patients/caregivers of member children required immunizations and regarding Women's Wellness issues using scripted tools
•Assists providers' offices with member specific missed appointments through member outreach
•Schedules and coordinates educational sessions for all applicable members as requested by clinical staff
•Answers incoming calls requesting services
•Makes accurate decisions based on prepared guidelines and scripted tools for review distribution (ie: Care Coordination, Care Oversight, Care Education and Care Support)
•Participates in the collection and reporting of information as defined by the monthly reporting requirements
•Uses reason and logic to solve problems during the review process and maintains a positive, professional and respectful attitude with peers and clients
•Researches and secures new telephone numbers to contact members
•Reviews and analyzes claims data in accordance with coordination and care education
•Monitors and works the queues assigned to care advocates
Other Responsibilities:
•Adheres to the policies and procedures of Community Health Solutions
•Maintains strict confidentiality of client, company and personnel information
•Demonstrates a strong commitment to the mission and values of the organization
•Adheres to company attendance standards
•Performs other duties as assigned
Supervisory Responsibilities: None
Competencies:
•Strong organizational and interpersonal skills
•Excellent written and verbal communication skills
•Detail oriented
•Ability to multi-task and work independently
Qualifications:
•A minimum of two (2) years of work experience as a Certified Nurse Assistant or Medical Assistant
•Proficiency in data entry skills
•Strong customer service/telephone skills
•An understanding of utilization management principles
Education and/or Experience:
A high school diploma or equivalent is required. Knowledge of medical terminology is required.
Certificates, Licenses, Registrations:
Certified Nurse Assistant or Certified Medical Assistant is required
Computer Skills:
Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel and Outlook
Environmental Factors/Physical Demands:
Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds. Location: Saint Petersburg
Compensation: $25,900 - $38,800
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Published at 01-31-2012
Viewed: 24 times