Personal Health Advocate

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

📋 Description

• Answer calls from members regarding various healthcare concerns (e.g., infertility, diseases, medications, etc.) and identify the best course of action to assist them while following established policies, procedures, and key performance indicators (KPIs).

• Foster relationships with members to collaboratively create and develop action plans by exceeding their initial requests.

• Help and educate members in comprehending their medical conditions, related health tests, test result interpretations, and available health options.

• Offer members choices in healthcare providers and services based on their clinical needs, geographical locations, and available benefits.

• Conduct research on providers through credentialing, educational verification, and affiliations with recognized medical centers within the member’s plan.

• Facilitate communication between members, treating physicians, and insurance companies.

• Record cases in the department's case management system utilizing approved processes and procedures.

• Stay informed about patient care procedures, including diagnosis, pre-certification, prior authorization, and pre-service and post-service denials.

• Continuously update knowledge on various health issues and medical procedures to provide high-quality feedback to members.

• Mentor new team members.

⛳️ Requirements

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

• A minimum of three to five years of clinical and/or medical management experience.

• Active and unrestricted State or Multi-State RN License.

• Proficient understanding of medical terminology to assist in identifying suitable care options.

• Strong communication skills and professional phone etiquette.

• Ability to explain complex issues clearly to employees and retirees.

• Highly effective listening skills.

• Strong problem-solving and issue resolution abilities.

• Excellent customer service and resolution skills.

• Strong organizational and administrative capabilities.

• Proficient in Microsoft Word and Excel.

• Ability to collaborate in a team-oriented environment.

🏝️ Benefits

• Opportunity to help individuals every single day.

• Comprehensive training provided to excel in your role.

• Supportive and friendly workplace atmosphere.

• Opportunities for professional growth and career advancement.