Quality Behavioral Health Advocate

Position Purpose:
Works with members and providers to close behavioral health care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through targeted member and provider outreach. Serves to collaborate with members and providers, to improve behavioral health HEDIS measures. Supports the implementation of quality improvement behavioral health interventions with identified members. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS. Conducts telephonic outreach, to members who are identified as needing behavioral health services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have. Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information. Provides coaching and training to new and current Quality Behavioral Health Advocates. Assist supervisor with special projects and implementing new initiatives towards better practice within the department as it pertains to day-to-day operations and technical resources. Acts as the team lead and source of information in supervisor's absence.

Key Details:
This position is fully remote/work from home. Applicants must reside in the state of FL and hold an active FL mental health/behavioral health licensure or RN with behavioral health experience.

Role will support FL Sunshine State Health Plan Seriously Mentally Ill Medicare and Medicaid members.

The position is full-time Monday - Friday, 8am - 5pm, eastern time zone.

- Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.

- Directly closes FUH, FUM, and FUA HEDIS care gaps with identified members.

- Assist members in getting connected to their behavioral health provider and/or assists members in finding a behavioral health provider for ongoing services.

- Schedules doctor appointments for members with behavioral health care gaps to access needed care services and close gaps in care.

- Conducts telephonic education with the member and their family, about care gaps identified, and barriers to care.

- Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.

- Arranges transportation for members as needed.

- Arranges follow-up appointments for members as needed.

- Documents all actions taken regarding contact related to member.

- Interacts with other departments including customer service to resolve member issues.

- Refers to case or disease management as appropriate.

- Completes special assignments and projects instrumental to the function of the department.

- Performs other duties as assigned.

- Acts as subject matter expert in regards to required departmental best practice, reports and data extract

- Takes lead on preparing and submitting projects, reports or assignments as needed to meet department initiatives.

- Assists with implementation of new and expanding health care QI/HEDIS initiatives.

- Represents supervisor in meetings or on special assignments.

- Helps establish process improvements leading to best practice and assist in implementing change movement within the department.

- Conducts audits and chart reviews on fellow Quality Behavioral Health Advocates to ensure best practice and proper protocol.

- Participates in and represents the plan at community, health department, collaborative and other organizational meetings focusing on quality improvement.

- Performs other duties as assigned.

- Complies with all policies and standards.

Education/Experience:
Required A Bachelor's Degree in Healthcare, Public Health, Nursing, psychology, Soci