About the Role
Position Overview: The Family Clinical Advocate is responsible for overseeing telephonic care management for members with complex and chronic care needs. This role involves assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member healthcare across the care continuum.
Key Responsibilities:
Ensure member access to appropriate services based on their health needs.
Conduct comprehensive assessments to identify individual needs and develop specific care management plans with defined objectives and goals.
Implement care plans by facilitating authorizations and referrals within the benefits structure or through extra-contractual arrangements.
Coordinate both internal and external resources to meet the identified needs of members.
Continuously monitor and evaluate the effectiveness of care management plans, making adjustments as needed.
Collaborate with Medical Directors and Physician Advisors to develop and refine care management treatment plans.
Negotiate reimbursement rates, where applicable.
Resolve provider, claims, or service-related issues as needed.
Contribute to the development of utilization and care management policies and procedures.
Requirements
Current, unrestricted RN compact license.Â
Bachelor’s degree in a health-related field.
A minimum of 5 years of clinical experience, or any combination of education and experience that provides an equivalent background.
About the Company
RepuCare, a certified Woman Owned Business (WBE), is a leader in providing innovative workforce solutions. We have partnered with a prominent managed care provider to seek a skilled and dedicated Family Clinical Advocate to join their team.