Care Advocate-RN Full-time Job
2 days ago Human Resources New York City 3 views Reference: WpmbkjnYazJJob Details
Position Purpose:
The Care Advocate - RN utilizes a collaborative process of assessment, planning, implementation, and evaluation, to engage, educate, and support members in making safe and effective health care decisions in support of optimal clinical outcomes. The Care Advocate – RN applies clinical expertise to facilitate individualized care coordination and optimization of services to improve patient outcomes and quality of life in a virtual environment.
-Participate in interdisciplinary team meetings and quality improvement activities
-Assess, plan, implement and evaluate individual member needs; facilitate problem solving, develop intervention strategies, provide support and guidance to members/families in support of the care plan
-Assess member's health status, resource utilization, medication adherence, treatment adherence
-Identify any gaps in care
-Perform medication reconciliations and make recommendations to physicians as appropriate
-Coach members regarding their current health conditions and develop individualized interventions, health management, and lifestyle changes.
-Collaborate with multidisciplinary team members, family and providers to facilitate the development, implementation and monitoring of care plans.
-Educate members and family/care givers on chronic conditions and wellness practices.
-Identify triggers and barriers to ensure care needs are being met; provide strategies to overcome barriers.
-Advocate for members to ensure treatment plans and interventions are successfully carried out
-Document care coordination interventions and outcomes.
-Develop relationships with internal and external stakeholders to identify ways to improve care coordination, services and treatment for members
-Support/assist with care transition (hospital, SNF, home, etc.).
-Collaborate and coordinate with health plan business units as needed to facilitate case resolution
-Coordinate benefits to ensure appropriate medical and behavioral healthcare.
-Understand the utilization review process to promote effective management of plan benefits and promote appropriate resource allocation. Document authorization request per standard
-Follow HIPAA guidelines in maintaining member confidentiality. Participate in compliance initiatives, educational programs, and complete mandatory training requirements
-Provide on-call and crisis coverage to members, as applicable
-Telephonic assessments may require some physical assessment skills. May involve the need to utilize office equipment, computers, phones, and other technological means of communication.
-Travel may be required to meet member needs, which include reliable means of transportation, and willingness to travel to member's home within the region/state.
