WellNet builds and optimizes smarter self-funded health plans for companies across the nation with 100 to 5,000 employees. Taking risk and leveraging our patented technology stack, we fix the unaffordable healthcare mess with ongoing education, stronger advocacy, and aligned incentives to combat the vested interests of traditional health insurance carriers. Our unique ability is doing whatever it takes – at the right pace – with our Crawl, Walk, Run approach to lower the cost of healthcare and improve the experience for companies and their people.
Clinical Advocate
Clinical Advocate
About WellNet Healthcare:
Reports To
Manager Advocate Services
Key Responsibilities
The Clinical Advocate will assist patients in navigating the complex Healthcare system with compassion and understanding. Providing clinical advice and assistance, diagnosis and treatment research and concierge patient advocacy
Key Activities
- Guide members with complex procedures/conditions- Clarify diagnosis & answer questions, research treatment options, education & direction of next steps.
- Provide clinical support to Advocacy team members by answering questions and providing clinical guidance as indicated.
- Become knowledgeable about our members’ benefits to effectively assist members.
- Ensure members get high quality, moderate-cost care wherever possible.
- Prescription appeal guidance- reviewing medical records to determine if sufficient information has been provided for review.
- Report review (precertification and others)- Identifying opportunities for steerage to high quality providers.
- Locating providers- assisting in locating the right medical provider for the members needs.
- Review of claims data for education on level of care (Emergency room vs Urgent care vs telemedicine)
- Assistance with outsourced pharmacy programs- securing documentation needed from physician/member
- Other duties as assigned
Qualifications
- Registered Nurse (RN) required; Bachelor’s in science of Nursing (BSN) preferred.
- Experience in health insurance industry a plus.
- Has a strong sense of professionalism and personal accountability.
- Strong Communication skills and phone etiquette.
- Highly effective listening skills.
- Analytic, problem solver, excellent organizational and technical skills and attention to detail are required.
You are aligned with these values:
- Optimism
- Accountability
- Respect
- Intelligence
- Hustle
- Adaptability
- Building long-termrelationships
This position offers a competitive compensation package, including health benefits, 401k, ongoing training, and paid vacation time.
Get to Know WellNet:
Check out our Educational Videos and Success Stories!
Located in Feasterville-Trevose, PA, 19053
Interested in Applying?
Please send an email to [email protected] and include a letter of interest and resume.