Vacancy expired!
Job Description:Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com.Job Summary:The Clinical Advocate supports the implementation and delivery of Sharecare’s Advocacy program by providing high quality telephonic/digital Case Management and/or condition management in a virtual call center environment. This is a patient centered model to help improve a member’s total well-being and do so in an appropriate, efficient and cost-effective manner. The Clinical Advocate coordinates with the member, their Primary Care Provider, Specialty Care Providers, ancillary services, and all other members of the health care team to support the members. The certified professional will use motivational interviewing and clinical skills to activate and help guide members to successful completion of health and well-being goals as well as develop care plans and communicate with the member’s healthcare providers to ensure consistent, high-quality care.The Clinical Advocate will work with Sharecare’s clinical analytics and clinical team to identify at risk members and provide Complex Case Management and strategies for health self-management through the duration of the Care Plan.Essential Job Functions:
Serve as an extension of the care team by collaborating with PCPs, specialists, other clinicians, and member to meet health care goals through development and implementation of Care Plans.
Utilize established documentation standards to maintain quality of Care Plan documentation to include member progress toward their established state of being and barriers to achievement of Care Plan objectives/outcomes.
Assess the member’s ongoing care needs and progress towards goals throughout the case duration and makes revisions as needed to address changes in the member’s condition, lack of progress toward goals of the care plan, preference changes, and transitions in care setting.
Coordinate plan of care with the provider with goals of member stabilization, decreased admissions, and medication management.
Follow program communication and referral mechanisms to assure there is seamless communication between PCPs, Specialists, and any other relevant members of the Care Team.
Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member.
Identify appropriate program partners and other healthcare providers/vendors as well as community resources. Refers and follows-up on referrals and outcomes.
Regarding clinical conversations, educate member on understanding benefit coverage, explanation of benefits, and reasons for coverage denials.
Ensure all health care services are medically necessary and provided in the most appropriate setting.
Assist member in finding alternative care options or assist member in working with payer to complete prior authorization or appeals process, when necessary.
Abide by Clinical Advocacy Program Description and Guidelines.
Meet productivity and quality metrics as outlined by leadership for each year.
Direct questions from providers or members to the Clinical Advocate Manager or Director when he/she identifies an opportunity for education or additional learning needs surrounding the programs that are outside of his/her understanding.
Complete training and annual clinical competency testing.
Actively participates in team huddles and contributes to the clinical learning.
Remain current on clinical knowledge via self-directed learning.
Specific Skills/ Attributes:
Exceptional motivational interviewing and case management skills.
Demonstrated ability to be self-directed, highly organized, multi-tasked capable, and proficient in problem solving skills.
Exceptional oral, written, and presentation skills.
Excellent customer service skills and ability to adapt approach to various personalities.
Demonstrated ability to work effectively with all levels of administrative and professional personnel.
Ability to proactively identify and assimilate quality improvement processes into practice.
Ability to extrapolate information from a variety of sources, including medical records, to create concise records that accurately depict the medical “story” of the member.
Comfort with managing multiple tasks and continually re-prioritizing.
Experience with medically oriented care plan documentation.
Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.
Ability to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Effective communication skills and ability to provide positive customer service to internal and external customers, including customers who may be demanding or otherwise challenging
Proven success in influencing patient and provider outcomes
Qualifications:
Current multi-state/compact Registered Nurse licensure in state of residence is required, with ability to obtain additional state licenses without restriction.
Microbiology course noted on nursing school transcript or college pre-requisites is required; BNS preferred.
Minimum of 3-5 years clinical experience; Telephonic Case Management experience and/or CCM certification preferred.
Specialty experience preferred in one or more of the following areas: NICU, Oncology, Transplant, Maternity, and/or Behavioral Health.
Training in motivational interviewing preferred.
Strong familiarity with technology inclusive of Electronic Medical Records, Microsoft Suite, and basic computer skills.
This position will be based in a home office which must satisfy all HIPAA and minimum internet connectivity requirements.
Ability to communicate with members, other members of the team, physicians, and plan representatives. Effective oral and written communication skills.
Ability to read, analyze, and interpret common scientific and technical journals. Ability to effectively present information to audiences with a variety of knowledge/skill levels
Sharecare and its subsidiaries are Equal Opportunity Employers and E-Verify users. Qualified applicants will receive consideration for employment without regard to race, color, sex, national origin, sexual orientation, gender identity, religion, age, equal pay, disability, genetic information, protected veteran status, or other status protected under applicable law.Sharecare is an Equal Opportunity Employer and doesn't discriminate on the basis of race, color, sex, national origin, sexual orientation, gender identity, religion, age, disability, genetic information, protected veteran status,or other non-merit factor.
Vacancy expired!