Personal Health Advocate

Your Mission: What Success Looks Like

Your primary accountability and Personal Health Advocate, RN 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 Guidance 

• Receive 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-Building 

• Educate 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 Navigation 

• Provide 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-Up 

• Maintain 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 Contribution 

• Stay 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 For 

You 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 Role 

You 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 Qualifications 

Education 

• BSN or RN degree from an accredited college or university (required) 

Licensure 

• Active and unrestricted State or Multi-State Registered Nurse license (required) 

Experience 

• Minimum 3–5 years of clinical and/or medical management experience 

Behavioral and/or mental health experience is strongly preferred, especially experience supporting members through sensitive, complex, or emotionally charged healthcare situations. 

Core Skills 

• 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 

Team Interface & Customer Service 

• Establish and maintain professional relationships with internal and external customers 

• Collaborate with team members to meet departmental goals 

• Deliver customer service that consistently exceeds expectations 

• Treat all individuals with dignity, respect, and professionalism 

• Escalate workflow or communication issues to leadership as appropriate 

Mental and Physical Requirements 

This position is fully remote and requires a dedicated, HIPAA-compliant workspace with reliable internet access. 

The nature of the work is sedentary, involving prolonged sitting and continuous computer and phone use. Essential functions include repetitive motion, typing, concentration, reading, and ongoing verbal and written communication throughout the workday. 

Related Duties as Assigned 

This job description describes the general nature and level of work performed and is not intended to be a comprehensive list of all activities, duties, or responsibilities. 

Job incumbents may be asked to perform other duties as required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions outlined above. 

Please contact your local Employee Relations representative to request a review of accommodations. 

Why Health Advocate? 

Because here, nursing expertise drives impact. 

You’ll join an organization that values structure, autonomy, accountability, and compassion — where your clinical judgment directly improves the lives of the members you serve.