PATIENT ADVOCATE I

3 weeks ago

Covina CA USA, United States Regal Medical Group, Inc. Full time
Job Description

Position Summary:

The Patient Advocate is designated to provide members with individualized service, allowing members the opportunity to make better informed, effective choices for their care. The Patient Advocate uses a combination of customer service skills, health system expertise, and strategic planning to optimize each member's care with a patient-centered approach. The Patient Advocate will work with Medical Management, Finance, Network and Data Management to provide comprehensive and timely solutions to member concerns.

The Patient Advocate works with members, health plan representatives, and the provider network. The Patient Advocate brings deep knowledge of the managed care model and expertise to our members, helping to bridge the information gap which often exists between members and the ever-changing healthcare system. The Patient Advocate communicates with members via telephone and is the person designated to help members see the provider of their choice. Such cases may be complex and/or high-risk, further requiring the expertise and knowledge that the Patient Advocate possesses, including but not limited to specific guidelines set forth by various Health Plans.

Essential Duties and Responsibilities include the following:

  • Types of referrals include but are not limited to: Non-Contracted provider requests, members needing extended options for their healthcare in unusual or high stakes clinical situations, and Transition of Care referrals. Transition of Care referrals include but are not limited to Third Trimester transfers, transfers who become effective during hospitalizations, and cases pertaining to Eligibility and/or Coordination of Benefits.
  • The Patient Advocate is the person charged with independently investigating issues of need and ensuring that members understand their options as to where and how they receive care.
  • The Patient Advocate uses his/her expertise to assess which referred cases are appropriate to work on, matching department resources with the most pressing patient needs. To accomplish this, the Patient Advocate must have exceptional critical thinking skills coupled with excellent decision-making skills.
  • Patient Advocates must be knowledgeable on all health plans' guidelines as well as the differences between their respective Lines of Business.
  • Patient Advocates must be able to independently research while working on any given case.
  • The Patient Advocate must have excellent time management skills and be able to prioritize their work. This includes cases that come from daily referrals as well as other special projects. Such cases are referred from Medical Management Departments, the Claims Department, In-Patient and Out-Patient Case Management, and Social Work.
  • Successful Patient Advocates have perseverance, drive and efficiency, are team-oriented, and possess leadership qualities.
  • The Patient Advocate is a skilled, empathic communicator to our members.
  • Must possess effective conflict resolution skills.
  • The Patient Advocate independently conducts research, accumulating clinical, network, and coverage data to adequately service a member's need. The Patient Advocate needs to be meticulous and detail-oriented to gather accurate information from providers, internal company reference material, as well as outside sources (e.g. contacts at contracted health plans).
  • Must be able to independently consider quantitative and qualitative data to make challenging patient and organizational decisions.
  • It is expected that the Patient Advocate leads initiatives in a corporate setting, and is able to work with all levels of the organization while maintaining Department goals and objectives.
  • Develops, monitors, and analyzes reports and identifies trends to improve program outcomes.
  • Develops program goals and objectives focused on improving member outcomes.
  • Must be skilled in formulating and testing hypotheses, and then develop and communicate downstream recommendations.
  • Educates members on all their given options on the HMO/Managed Care model.
  • Must have the drive to become an expert in each line of business in order to help members at all levels of the company.
  • Assists the Medical Directors with high-risk cases.
  • Work in collaboration with the Medical Management team to ensure compliance with regulatory and health plan requirements.
  • Complete assigned tasks accurately and within specified time limits.
  • Develop working relationships with health plan counterparts to facilitate timely outcomes on high-risk cases.
  • Able to anticipate customer needs and understands the wants and needs of members. Must be able to listen for cues and respond to the level of intervention needed.
  • Follows through with requests, sharing of critical information, and getting back to individuals in a timely manner.
  • Treats members and their families with respect and dignity. Functions as liaison between administration, members, physicians, and other healthcare providers.
  • Performs other duties as assigned.

The pay range for this position at commencement of employment is expected to be between $26 - $28 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

  • Employer-paid comprehensive medical, pharmacy, and dental for employees
  • Vision insurance
  • Zero co-payments for employed physician office visits
  • Flexible Spending Account (FSA)
  • Employer-Paid Life Insurance
  • Employee Assistance Program (EAP)
  • Behavioral Health Services

Savings and Retirement:

  • 401k Retirement Savings Plan
  • Income Protection Insurance

Other Benefits:

  • Vacation Time
  • Company celebrations
  • Employee Assistance Program
  • Employee Referral Bonus
  • Tuition Reimbursement
  • License Renewal CEU Cost Reimbursement Program
  • Business-casual working environment
  • Sick days
  • Paid holidays
  • Mileage

Requirements

Education and / or Experience:

  • Bachelor's degree in healthcare or related discipline preferred; exceptional experience considered in lieu of degree.
  • Knowledge of Healthcare and Managed Care required.
  • Recent experience working with patients in a variety of health care or social services settings which can include hospitals, doctor's office, dental office, home health, hospice care, social services, mental health, health plan and child protective services.
  • Bilingual (Spanish, Farsi, Armenian, Vietnamese) and/or bi-cultural strongly preferred
  • Understanding of Health Care Markets including Medicaid, Medicare and private health insurance
  • 5+ years of outreach experience serving low income and/or older adult populations
  • 3 - 5 years project management experience, preferably in a health care setting
  • Skilled in the use of software including Excel, PowerPoint and Word; proficiency in higher functions of Word and Excel required (mail merge, data organization/cleaning functionality, template creation and use.)
  • Excellent time management skills (on time, within estimated workload, according to scope, and with flexibility when required).
  • Strong interpersonal skills (assertiveness, not afraid to challenge constructively, fast learner, client oriented, respect of commitments, etc.)
  • Creative and action-oriented mindset.
  • Ability to act autonomously, bring structure and organization to work.
  • Records of academic and managerial or professional achievement.
  • Ability to work collaboratively in a team environment.
  • Exceptional analytical and quantitative problem-solving skills.
  • Ability to work effectively with people at all levels in an organization.
  • Able to combine strategic and analytical insights with a passion for healthcare.
  • Must be proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
  • Ability to deal with responsibility with confidential matters.
  • Ability to work in a multi-task, high-stress environment.
  • Ability to prioritize.
  • Ability to meet deadlines and ensure regulatory compliance.

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