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Personal Health Advocate
Health Advocate. Receive inbound member calls about healthcare issues including infertility, chronic disease, medications, and diagnoses .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical and medical management, with a strong understanding of medical terminology and healthcare systems. Capable of effectively communicating complex healthcare topics and advocating for member needs while maintaining compliance with HIPAA regulations.
Highest-signal resume keywords
BSN Or RN DegreeActive And Unrestricted State Or Multi-State Registered Nurse License3–5 Years Of Clinical And/or Medical Management ExperienceStrong Understanding Of Medical TerminologyExcellent Verbal Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ManagementMedical TerminologyHealthcare SystemsCase ManagementDocumentationProblem-SolvingIssue ResolutionOrganizational AbilitiesTypingVerbal And Written Communication
Soft Skills
Effective ListeningCollaborationCompassionate CommunicationRelationship BuildingMentoring
Tools & Technologies
Microsoft WordMicrosoft ExcelCase-Management Systems
Certifications & Qualifications
Registered Nurse License
Industry Keywords
HealthcarePatient CareBehavioral HealthHIPAA ComplianceMember Advocacy
About the role
Key responsibilities & impact- Receive inbound member calls about healthcare issues including infertility, chronic disease, medications, and diagnoses
- Assess member needs and determine appropriate courses of action according to policies, procedures, and KPIs
- Take ownership of member cases and encourage continued engagement
- Educate members about medical conditions, diagnostic testing, test results, and treatment options
- Explain complex medical and benefit information clearly and compassionately
- Build trusted relationships that support member participation in healthcare decisions
- Provide provider and service options based on clinical needs, geographic location, and benefit coverage
- Research providers through credentialing, education verification, and medical-center affiliations
- Facilitate communication among members, physicians, and insurance carriers
- Assist with appointments, medical-record transfers, access issues, and benefit provisions
- Advocate for earlier appointments and removal of care barriers
- Support prescription, pre-service fee negotiation, and authorization-related needs
- Document cases accurately and timely in approved case-management systems
- Place outbound follow-up calls and respond to delegate box, answer service, and after-hours calls
- Escalate cases to supervisors or internal clinical resources
- Stay current on patient care procedures, diagnoses, authorizations, denials, and healthcare practices
- Mentor new team members and collaborate with colleagues to maintain service excellence and balanced workflows
- Establish professional relationships with internal and external customers and meet departmental goals
Requirements
What you’ll need- BSN or RN degree from an accredited college or university (required)
- Active and unrestricted State or Multi-State Registered Nurse license (required)
- Minimum 3–5 years of clinical and/or medical management experience
- Behavioral and/or mental health experience strongly preferred
- Strong understanding of medical terminology and healthcare systems
- Excellent verbal communication skills and professional phone presence
- Ability to explain complex healthcare topics to diverse populations
- Highly effective listening, problem-solving, and issue-resolution skills
- Strong organizational and administrative abilities
- Proficiency with Microsoft Word and Excel
- Ability to work effectively in a collaborative, remote team environment
- Dedicated HIPAA-compliant workspace with reliable internet access
- Ability to perform prolonged sitting, continuous computer and phone use, repetitive motion, typing, concentration, reading, and ongoing verbal and written communication
Benefits
Comp & perks- Training provided to do the job well
- Supportive supervisors and staff
- Opportunities for career growth and advancement
- Full-time remote work
- Dedicated HIPAA-compliant workspace requirement
- Reasonable accommodations for individuals with disabilities