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

Health Advocate is the nation’s leading provider of health advocacy, navigation, well-being and integrated benefits programs. For 20 years, Health Advocate has provided expert support to help our members navigate the complexities of healthcare and achieve the best possible health and well-being. Our solutions leverage a unique combination of best-in-class, personalized support with powerful predictive data analytics and a proprietary technology platform to address nearly every clinical, administrative, wellness or behavioral health need. Whether facing common issues or an unprecedented challenge like COVID-19, our team of highly trained, compassionate experts work together to go above and beyond expectations, making healthcare easier for our members and ensuring they get the care they need.

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. Related Duties as Assigned The job description documents the general nature and level of work but is not intended to be a comprehensive list of all activities, duties, and responsibilities required of job incumbents Consequently, job incumbents may be asked to perform other duties as required Also note, that reasonable accommodations may be made to enable individuals with disabilities to perform the functions outlined above Please contact your local Employee Relations representative to request a review of any such accommodations

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 Team Interfaces/Customer Service 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