Personal Health Advocate

Why is Health Advocate a great place to work? For starters, Health Advocate employees enjoy helping people every single day. Employees are given the training they need to do their jobs well, and they work with supervisors and staff who are supportive and friendly. Employees have room to grow, and many of Health Advocate's supervisors are promoted from within the company. Join our award winning team!2025:Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner2024: Excellence in Customer Service Awards: Organization of the Year (Small) Stevie® Awards for Sales & Customer Service: Customer Service Department of the Year – Healthcare, Pharmaceuticals, and Related Industries, Bronze Winner Best in Biz Awards: Most Customer-Friendly Company of the Year – Medium and large category (Silver) As part of Teleperformance in the US, we were also named #95 in the 2024 ‘Fortune 100 Best Companies to Work For®’ in the USA by Great Places to Work (GPTW®)**EVENING SHIFTS**Your Mission: What Success Looks LikeYour primary accountability and Personal Health Advocate, Registered Nurse is to deliver high-quality, member-centered clinical advocacy while meeting service, quality, and case management standards. Success in this role includes consistently achieving: 🔹 Member Advocacy & Clinical GuidanceReceive inbound member calls related to a wide range of healthcare issues (e.g., infertility, chronic disease, medications, diagnoses) Assess needs and determine the best course of action while adhering to established policies, procedures, and performance indicators (KPIs) Take ownership of member cases by going beyond the initial request and encouraging continued engagement 🔹 Education, Trust & Relationship-BuildingEducate members on their medical conditions, diagnostic testing, test results, and available treatment options Explain complex medical and benefit-related information clearly and compassionately Build trusted relationships that empower members to actively participate in their healthcare decisions 🔹 Care Coordination & System NavigationProvide members with options for healthcare providers and services based on clinical needs, geographic location, and benefit coverage Research providers through credentialing, education verification, and affiliations with recognized medical centers Facilitate communication between members, treating physicians, and insurance carriers Assist with scheduling and re-scheduling appointments, transferring medical records, resolving access issues, and clarifying benefit provisions Intercede on behalf of members to obtain earlier appointments or remove barriers to care Support members with prescriptions, pre-service fee negotiations, and authorization-related challenges 🔹 Case Management, Documentation & Follow-UpMaintain accurate, timely documentation using approved case management systems and procedures Place outbound follow-up calls when issues cannot be resolved during the initial interaction Respond to delegate box, answer service, and after-hours calls as required Escalate cases appropriately and on a timely basis to supervisors or internal clinical resources 🔹 Professional Growth & Team ContributionStay current on patient care procedures, diagnoses, authorizations, denials, and evolving healthcare practices Mentor and support new team members as needed Collaborate with colleagues to maintain service excellence and balanced workflows Who You Are: The Leader We’re Looking ForYou are an experienced nurse who brings clinical judgment, composure, and accountability to every interaction. You naturally demonstrate: Ownership and follow-through You take responsibility for member outcomes and see cases through with care and precision. Empathy grounded in professionalism You listen deeply and respond with compassion while maintaining clarity, confidence, and appropriate boundaries. Strong critical thinking You quickly synthesize clinical information, prioritize what matters, and determine effective next steps. Clear and confident communication You explain complex medical and insurance concepts in a way members can understand and trust. A commitment to quality and results You are motivated by accuracy, meaningful resolution, and delivering an exceptional member experience. Curiosity and continuous learning You stay current on healthcare trends, systems, and procedures to provide thoughtful, informed guidance. Who Will Thrive in This RoleYou will thrive in this role if you are comfortable balancing compassionate member conversations with a fast-paced, high-volume phone environment. This is a strong fit for someone who can stay organized, document thoroughly and in real time, follow cases through to resolution, and maintain a calm, professional presence while managing multiple member needs throughout the day. Minimum QualificationsEducationBSN or RN degree from an accredited college or university (required) L