[Hiring] Personal Health Advocate @LanguageLine Solutions

Role Description

Your primary accountability as a Personal Health Advocate, Registered Nurse 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.

Qualifications

• 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 is strongly preferred, especially experience supporting members through sensitive, complex, or emotionally charged healthcare situations.

Requirements

• 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.

Benefits

• 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.