Personal Health Advocate (Registered Nurse) Evening Shift (12:30-9:00 pm EST OR 1:00-9:30 pm EST)

LanguageLine Solutions

7d•Remote

About The Position

At Health Advocate, we are committed to providing our customers with services that improve the health, well-being and productivity of their employees. The Personal Health Advocates are a dedicated team of Registered Nurses who assist our members in navigating the healthcare system by facilitating access to healthcare providers, health and benefit information, health services and resources and entitled benefits coverage.

Requirements

Education- BSN or RN degree from an accredited college or university required
Minimum three to five years clinical and/or medical management experience
Active and unrestricted State or Multi-State RN License
Understanding of medical terminology to assist in locating appropriate care options
Strong Communication skills and phone etiquette
Strong ability to explain complex issues to employees/retirees
Highly effective listening skills
Strong problem solving/issues resolution skills
Excellent customer service and customer resolution skills
Organizational and administrative skills
Experience with Microsoft Word and Excel
Ability to work in a team environment
This position is a remote position. The employee will need to have a dedicated HIPPAA compliant work space.
Have access to internet and router.
The nature of the work in this position is sedentary and the incumbent will be sitting most of the time
Essential physical functions of the job include fingering, grasping, pulling hand over hand, and repetitive motions to utilize general computer software/hardware continuously throughout the work day
Essential mental functions of this position include concentrating on tasks, reading information, and verbal/written communication to others continuously throughout the work day

Responsibilities

Receive calls from members in regards to various healthcare issues (e.g., infertility, disease, medication, etc.) and determine best course of action/s to assist the members while adhering to established policies, procedures, and key performance indicators (KPIs) (e.g. case close targets, abandon rates, member follow up, all quality indicators, etc.)
Build relationships with members in order to collaborate and develop plans of action by going above and beyond members’ initial requests, taking responsibility for members’ case records, and encouraging members to call back with future issues/ questions.
Assist and educate members in understanding their medical conditions, associated health testing, test result interpretation, and health options available to them.
Provide members choices in medical care providers and services based on the members’ clinical needs, geographic locations and available benefit offerings.
Research providers through credentialing, education checks and affiliations with notable medical centers within the member’s plan
Facilitate communication among members, treating physicians, and insurance carriers, which may include assisting members with asking necessary health questions to physicians or clarifying insurance plan provision
Take appropriate steps on behalf of members by assisting with scheduling health appointments, re-scheduling health appointments, facilitating record and information transfers, and researching and resolving various problems as applicable
Document cases in the department’s case management system using approved processes and procedures
Escalate cases appropriately and on a timely basis to supervisor or internal resources for review as applicable
Keep up-to-date on patient care procedures which include diagnosis, pre-certification, prior authorization, pre-service and post-service denials
Continuously stay up to date on various health issues and medical procedures necessary to offer top of the line feedback to members
Intercede for the member to obtain an earlier appointment.
Help members obtain prescriptions
Help members with pre-service fee negotiations
Place outbound follow up calls for issues that cannot be resolved during the initial call
Respond to member cases in delegate box, answers and after hours calls
Mentor new team members
Establish and maintain a professional relationship with internal/external customers, team members and department contacts
Cooperate with team members to meet goals or complete tasks
Provide customer service that exceeds customer expectation
Treat all internal/external customers, team members and department contacts with dignity/respect
Escalate work flow and communication issues to supervisor