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    clinical care specialist - Dallas, TX , USA, United States - Employer Direct Healthcare

    Employer Direct Healthcare
    Employer Direct Healthcare Dallas, TX , USA, United States

    3 weeks ago

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    Description
    Clinical Care Specialist


    The goal of enhanced clinical care navigation is to better engage patients directly to support their selection of top-quality providers available through SurgeryPlus.

    Through this effort, the Clinical Care Specialist will drive improved patient experience and stronger utilization of our services.


    Professional RN or PA with orthopedic surgery (General & Spine) and bariatrics clinical experience, who will join a clinical team offering individualized assistance to patients as they navigate their surgery journey.

    The Clinical Care Specialist will help the patient understand the SurgeryPlus program and guide them in determining which SurgeryPlus surgeon is the appropriate choice given their needs and preferences.

    The scope of this position includes provider selection, consult, and procedure touchpoints with members based on their clinical needs. This role provides education and resources to facilitate and support informed decision making for the patient.

    The appropriate candidate will have the skills and knowledge to answer questions from patients as they consider which surgeon is right for them, leveraging various resources of data (from quality review materials to network contracting information) to better inform the patient of their surgeon options.

    Ideally this is a Nurse or Physician Assistant preferably with office-based surgical experience, with demonstrated ability to communicate effectively with both patients and providers.


    Location:
    Hybrid (Dallas, TX) or Remote

    Responsibilities and Duties


    • Increase the number of patients selecting an EDH recommended provider for their surgery by:
    • Educating the patient on the SurgeryPlus program, the importance of certification and quality, and how to assess a surgeon
    • Articulating the quality of the specific providers recommended to the patient
    • Answering questions/addressing concerns related to our providers
    • Single point of contact for the clinical related questions based on patient needs
    • Ensure appropriateness of provider recommendations by:
    • Thoroughly understanding the EDH network of providers
    • Reviewing patient information to better inform appropriateness of provider selected to meet their unique needs
    • Comparing of those recommendations to existing surgeons where applicable
    • Understanding and appropriately communicating nuances around contracted facilities (e.g., direction if a hospital is needed)

    Duties and Expectations:

    • Managing high volume inbound and outbound calls, engaging and enabling patients to use our benefit through a more tailored provider recommendation discussion centered around quality
    • Providing education and support to the patient and families
    • Educating patients on provider choices and in turn providing a comprehensive understanding of the surgery and our provider network
    • Meeting and exceeding metrics of success as outlined by management
    • Documenting feedback and opportunities to increase conversion rate
    • Collaborating with the Member Services and Network teams to understand the various nuances that should be highlighted to the patient
    • Contributing to and collaborating with Member Services and Network team members to positively impact patient outcomes and patient experiences.
    • Establishing progress and gathers feedback:
    • Manages surveys regarding patient satisfaction with the services received, services provided, and the impact of patient education, programs, and counseling.
    • Prepare and deliver progress reports detailing programmatic activities for the department as required.
    • Functioning in an organized and time conscious manner

    Requirements:

    • Minimum of 5 years of progressive office practice experience with a particular focus on either: Spine, General Ortho, or Bariatrics
    • Bachelor of Nursing Degree or Physician Assistant Degree preferred
    • Experience in Orthopedics or Bariatrics required
    • Knowledge in navigation health programs and demonstrated experience communicating with patients in this regard
    • Ability to navigate various data sources, run reports and engage various stakeholders to better synthesize information for patients in their provider choice journey
    • Graduated from accredited nursing or physician assistant school
    • Bilingual preferred but not required
    • Overall computer literacy with proficiency in Windows-based software and Microsoft Office

    Benefits:

    • Medical Insurance
    • Dental Insurance
    • Vision Insurance
    • Short & Long Term Disability
    • Life Insurance
    • 401k with company match
    • Paid Time Off
    • Paid Parental Leave

    Location:
    Dallas, TX preferred. Hybrid and remote possible.
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