Personal Health Advocate

This is a fully remote position, open to applicants in United States.

📋 Description

• Handle incoming calls from members regarding healthcare concerns, including infertility, chronic illnesses, medications, and diagnoses.

• Evaluate member requirements and decide on suitable actions in accordance with policies, procedures, and KPIs.

• Take responsibility for member cases and promote ongoing engagement.

• Inform members about medical conditions, diagnostic tests, test outcomes, and treatment alternatives.

• Clearly and compassionately elucidate complex medical and benefit information.

• Offer healthcare provider and service options based on clinical necessities, geographical location, and benefit coverage.

• Conduct provider research through credentialing, education validation, and medical center affiliations.

• Facilitate communication among members, physicians, and insurance companies.

• Assist with scheduling appointments, transferring medical records, addressing access issues, and explaining benefit provisions.

• Intervene to secure earlier appointments or eliminate care barriers.

• Support members with prescription management, pre-service fee negotiations, and authorization challenges.

• Ensure accurate and timely documentation of cases.

• Make outbound follow-up calls and address delegate box inquiries, answer services, and after-hours communications.

• Elevate cases to supervisors or internal clinical resources when necessary.

• Keep updated on patient care processes, diagnoses, authorizations, denials, and healthcare practices.

• Mentor new team members and work collaboratively with colleagues to uphold service excellence.

• Build professional relationships with internal and external customers while achieving departmental objectives.

⛳️ Requirements

• Bachelor of Science in Nursing (BSN) or Registered Nurse (RN) degree from an accredited institution (required).

• Active and unrestricted State or Multi-State Registered Nurse license (required).

• At least 3–5 years of clinical and/or medical management experience.

• Experience in behavioral and/or mental health is highly preferred.

• Strong grasp of medical terminology and healthcare systems.

• Outstanding verbal communication skills and a professional phone demeanor.

• Capability to explain intricate healthcare subjects to diverse populations.

• Highly effective listening, problem-solving, and issue-resolution abilities.

• Strong organizational and administrative skills.

• Proficient in Microsoft Word and Excel.

• Ability to function effectively within a collaborative remote team setting.

• Comfortable operating in a fast-paced, high-volume call environment.

• Skill in thorough real-time documentation.

• Willingness to work evening shifts: 12–8:30 pm EST, 12:30–9 pm EST, or 1–9:30 pm EST.

• Must have a dedicated HIPAA-compliant workspace with reliable internet access.

• Capability to engage in prolonged sitting, consistent computer and phone usage, repetitive motions, typing, concentration, reading, and ongoing verbal and written communication.

🏝️ Benefits

• Comprehensive training provided.

• Opportunities for growth and internal promotions.

• Fully remote working environment.

• Requirement for a dedicated HIPAA-compliant workspace.

• Reasonable accommodations available for individuals with disabilities.