MEMBER ADVOCATE III - LVN

Job DescriptionThe Member Advocate Level serves our patients, members, and providers to facilitate the delivery of healthcare acting as an ambassador on behalf of the member. In a call center work-environment, the Member Advocate deploys empathy, problem-solving skills and perseverance to exceed the expectations of its customers and partners. Member Advocates respond to all member and provider inquiries delivering top-caliber concierge service through multiple communication channels. With the assistance of data and technology, member advocates guide members through scheduling, benefits and care services to ensure a high value and personalized experience. This role is central to ensure a uniquely Hoag experience and a successful journey through the healthcare system. Member advocates operate in a continual learning experience empowered to self-correct and influence process improvement and technology improvement.
Level II and aboveMember Advocate Level II develops a specialized expertise in a specific domain (Health Plan benefits, Provider Disputes, Professional chat etiquette guidelines, etc.). The Level II advocate has a high proficiency to address complex issues with claims and referrals. The Level II advocate will also perform outreach calls to assist with wellness activities.
Level IIIMember Advocate Level III is a mentor on the team that leads aspects of the training function, is a subject matter expert in a variety of knowledge sets, and effectively handles service recovery functions, and is a change agent for service delivery and process improvement activities.
Essential Functions:

• Respond to the inbound member and provider and healthcare entity communications (call, text, email, chat, etc.) adhering to designated protocols and service responses while providing exceptional customer service
• Assist in cases requiring additional non-clinical follow-up and care coordination, including, but not limited to: enrollment and eligibility, scheduling appointments, plan benefits, claims, referrals provider network inquiries, care management program assistance, and obtaining ancillary results and medical records
• Communicate and collaborate with interdisciplinary teams; when needed ensure effective soft transfers with utilization management, clinical care, and wellness teams
• Accurately collects and documents the appropriate level of information to facilitate resolution and identify trends
• Function as a detective to find creative solutions to difficult problems
• Ensure problem resolution or smoothly transition to a higher level advocate or manager when appropriate
• Participate in process improvement activities by openly sharing thoughts, ideas and constructive feedback to technical, Hoag experience, and management steams
• Recognizes the presence of patient issues that may require immediate clinical assessment or action, based on BLS training and the Red Flag List, and notifies clinical staff
• May assemble and send new patient packets, registration packets, and history/physical forms prior to scheduled appointments.
• Responds appropriately to inquiries and complaints. Can troubleshoot and problem solve independently as situations occur
• Ensures adherence to daily operating metrics systems
• Other duties and projects as assigned

Level II and above

• Outreach to members and patients to facilitate onboarding; persuade participation in wellness and health promotion activities such as ensuring effective transitions of care; arranging for completion of gaps in care, scheduling annual wellness visit; and to communicate authorization approvals and denials within required time frames
• Masters a specialized skill and assist with the education and training of peers
• Assist with organizing topics for daily team huddles and meetings and ensure follow-ups and action items are captured and assigned
• Other duties and projects as assigned

Level III

• Serve as a role model for Member Advocate team adhering to the Hoag values, assisting with onboarding, training and coaching.
• Serves as a source for ideation and process redesign effectively championing new workflows, new technology in automation and decision support
• Co-manage cases with nurses and social workers, ensuring all assigned tasks are completed on time
• Ensure problem resolution and participate in service recovery activities when appropriate
• Other duties and projects as assigned

Education, Training and ExperienceRequired:Level I

• High School Diploma or equivalent
• 3 years of customer service experience in any industry Or meets all requirements in Level II or Level III.

Level II and above

• Associates degree or higher OR obtaining a bachelor’s degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse OR other professional clinical certification. Equivalent years of relevant experience will be considered in lieu of education.
• 2 years of experience within a call center or healthcare setting with direct patient interaction.

Level III

• Bachelor’s degree or obtaining a bachelor’s degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse. Equivalent years of relevant experience will be considered in lieu of education.
• Previous work experience working as a care coordinator, member advocate, or health care unit coordinator or similar health related job function.

Preferred:Level II

• Bachelor’s degree or obtaining a bachelor’s degree in healthcare related field OR certified medical assistant OR Licensed Vocational Nurse
• Previous work experience working as a care coordinator, member advocate, or health care unit coordinator

Level III

• Certified Medical Interpreter

Skills or Other QualificationsRequired:Level III

• Passionate, excited, and carry a positive attitude; a strong desire to simplify healthcare
• Experience in providing excellent customer service and have a heighten the empathetic ability
• Skills to multi-task and manage competing priorities can triage appropriately and can apply critical thinking to solve problems
• Tech savvy and possess a capability to quickly learn new applications
• Ability to maintain composure and compassion while addressing a high volume of competing tasks
• Comfortable with ambiguity and open to collaborative environments
• Strong moral compass and commitment to Hoag’s values
• Motivated to learn, continually improve and operate to ones fullest potential
• Bilingual skills (preferred)

License and CertificationsRequired: NonePreferred:
Level III

• Certified medical assistant OR Licensed Vocational Nurse (LVN), Certified Medical Interpreter