Health Plan Member Advocate

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Location: Remote

Description

POSITION PURPOSE:

The Member Advocate (Health Plans) is an integral part of a cross-functional clinical team comprised of health plan coordinators, physicians and other nurses that facilitates the delivery of healthcare information to Best Doctors members and clients.  The member advocate is a case management position focused ensuring clinical quality and the highest level of member and client satisfaction on all cases across the full spectrum of Best Doctors service lines. 

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

  • Works with a designated clinical team to ensure adequate phone coverage for live triage/warm transfers of members and also to ensure member’s scheduled call back appointments are met on time.
  • Maintains his/her own availability, including evenings within his/her set shift for scheduling of member intakes via scheduling software and warm handoffs.
  • Obtains a comprehensive health history and creates clinical vignettes for an array of service lines by leading members through a systematic and dynamic intake assessment to capture all relevant data about their current condition and health history.
  • Directs members to the most appropriate Best Doctors service based on the treating teams request for service and the members medical condition by utilizing current scripting; sets appropriate member expectations for each process.
  • Utilizes the company’s proprietary database to help connect members to Best Doctors associated physicians for appointments.
  • Engages new physicians to participate in consultation services for Best Doctors.
  • Conducts member health coaching and provides treatment decision support service via printed educational materials and videos.
  • Escalates questions/concerns regarding cases to Operations Manager and/or Medical Director.
  • Collaborates with clinical leadership to resolve member and client complaints. Anticipates the needs of members and clients to reduce the occurrence of member and client complaints.
  • Ensures clear and thorough documentation within case management system as well as within each case.
  • Performs clinical member satisfaction and clinical follow up per company policies
  • Works in partnership with the clinical team as needed in support of case development.
  • Provides clinical support and guidance to support staff in regards to case related inquiries.
  • Provides clinical support and coaching to referring clinicians from the health plan and provider clients per company policies and as needed
  • Participates in ongoing training, focus groups, activities to help the business unit enhance delivery of clinical and service quality

DESIRED MINIMUM QUALIFICATIONS:

Education and Experience:

  • Registered Nurse
  • BSN Preferred
  • 5 years recent experience in the acute care setting

Necessary Knowledge:

  • Med-surg background preferred
  • Excellent written and verbal communication skills
  • Outstanding team player & strong interpersonal skills
  • Bilingual-Spanish Speaking a plus
  • Strong organizational skills and the ability to multitask with ease
  • Strong clinical knowledge base
  • Quality driven with a focus on flawless customer service
  • Ability to work independently but recognize when escalation is warranted
  • Proficiency using technology and software  including Microsoft Word, Excel, Outlook    

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

  • While performing the duties of this job, the employee is regularly required to talk and hear.
  • The employee is frequently required to sit; use hands to finger; and occasionally reach with hands and arms.
  • The employee may occasionally lift up to 5 lbs. 
  • This role routinely uses standard office equipment such as computers, phones, photocopiers, and fax machines.

Work Environment:

This job is performed in a home office; the employee is responsible for setting up their home office in line with the recommended guidelines, and must be free of reasonable health and safety hazards.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job.   Duties, responsibilities and activities may change at any time with or without notice.

This position is essential to the day to day operation of the company. Because of this the employee may be asked to work from home during emergency office closures.





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