LPN/Patient Care Advocate

This position requires commuting up to 2.5 hours within the Saginaw/Genesee County Area. The role is remote with significant travel to provider offices for face-to-face interactions. The work environment includes telephonic outreach and collaboration with various departments.

Job Description

The Patient Care Advocate 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. This role involves collaborating with providers in the field to improve HEDIS measures, providing education on HEDIS measures and coding, and supporting the implementation of quality improvement interventions and audits. The advocate will assist in resolving deficiencies impacting plan compliance with State and Federal standards for HEDIS and conduct telephonic outreach to members needing preventive services. Additionally, this position involves scheduling doctor appointments, arranging transportation, and connecting members with community-based resources, all while maintaining confidentiality of business and protected health information.

ResponsibilitiesAct as a liaison and member advocate between the member/family, physician, and facilities/agencies.Represent the company in the provider community with the provider and office staff.Advise and educate Provider practices on appropriate HEDIS measures and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.Assess provider performance data to identify and strategize opportunities for provider improvement.Collaborate with Provider Relations to enhance provider performance in areas of Quality, Risk Adjustment, and Operations (claims and encounters).Schedule doctor appointments for members to access needed preventive care services and close gaps in care.Conduct face-to-face education with members and their families about identified care gaps and barriers to care.Perform telephonic outreach and health coaching to members to support quality improvement, regulatory, and contractual requirements.Arrange transportation and follow-up appointments for members as needed.Document all actions taken regarding member contact.Interact with other departments, including customer service, to resolve member issues.Refer members to case or disease management as appropriate.Complete special assignments and projects instrumental to the function of the department.Essential SkillsMinimum of 4 years of experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.2+ years of direct work experience in patient care, social work, quality improvement, or health coaching.Additional Skills & QualificationsOne of the following licenses/certifications is preferred: Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), Licensed Registered Nurse (RN).

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At 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 people

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If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.