Personal Health Advocate

LanguageLine Solutions

2d•Remote

About The Position

Health Advocate is seeking a Personal Health Advocate, RN to deliver high-quality, member-centered clinical advocacy while meeting service, quality, and case management standards. Success in this role involves consistently achieving member advocacy and clinical guidance, educating members on their medical conditions, building trusted relationships, coordinating care, navigating the healthcare system, managing cases, documenting accurately, and contributing to professional growth and team efforts. The company emphasizes a supportive work environment with opportunities for growth and internal promotions. Health Advocate is the nation's leading provider of health advocacy, navigation, well-being, and integrated benefits programs, leveraging a combination of personalized support, data analytics, and a technology platform to address various health needs.

Requirements

BSN or RN degree from an accredited college or university (required)
Active and unrestricted State or Multi-State Registered Nurse license (required)
Minimum 3–5 years of clinical and/or medical management experience
Strong understanding of medical terminology and healthcare systems
Excellent verbal communication skills and professional phone presence
Ability to explain complex healthcare topics to diverse populations
Highly effective listening, problem-solving, and issue-resolution skills
Strong organizational and administrative abilities
Proficiency with Microsoft Word and Excel
Ability to work effectively in a collaborative, remote team environment
Establish and maintain professional relationships with internal and external customers
Collaborate with team members to meet departmental goals
Deliver customer service that consistently exceeds expectations
Treat all individuals with dignity, respect, and professionalism
Escalate workflow or communication issues to leadership as appropriate
Dedicated, HIPAA-compliant workspace with reliable internet access
Prolonged sitting and continuous computer and phone use
Repetitive motion, typing, concentration, reading, and ongoing verbal and written communication throughout the workday

Nice To Haves

Behavioral and/or mental health experience is strongly preferred, especially experience supporting members through sensitive, complex, or emotionally charged healthcare situations.

Responsibilities

Receive inbound member calls related to a wide range of healthcare issues (e.g., infertility, chronic disease, medications, diagnoses)
Assess needs and determine the best course of action while adhering to established policies, procedures, and performance indicators (KPIs)
Take ownership of member cases by going beyond the initial request and encouraging continued engagement
Educate members on their medical conditions, diagnostic testing, test results, and available treatment options
Explain complex medical and benefit-related information clearly and compassionately
Build trusted relationships that empower members to actively participate in their healthcare decisions
Provide members with options for healthcare providers and services based on clinical needs, geographic location, and benefit coverage
Research providers through credentialing, education verification, and affiliations with recognized medical centers
Facilitate communication between members, treating physicians, and insurance carriers
Assist with scheduling and re-scheduling appointments, transferring medical records, resolving access issues, and clarifying benefit provisions
Intercede on behalf of members to obtain earlier appointments or remove barriers to care
Support members with prescriptions, pre-service fee negotiations, and authorization-related challenges
Maintain accurate, timely documentation using approved case management systems and procedures
Place outbound follow-up calls when issues cannot be resolved during the initial interaction
Respond to delegate box, answer service, and after-hours calls as required
Escalate cases appropriately and on a timely basis to supervisors or internal clinical resources
Stay current on patient care procedures, diagnoses, authorizations, denials, and evolving healthcare practices
Mentor and support new team members as needed
Collaborate with colleagues to maintain service excellence and balanced workflows