Patient Health Advocate, Field

As a leading provider of outcomes-driven care for individuals and communities living with chronic conditions, Somatus is helping patients across the country enjoy More Healthy Days at Home™.

Care at Somatus goes beyond treatment. Through a whole‑person approach, we deliver outcomes‑driven integrated care and show up #SomatusStrong for our patients and teammates. We partner closely with health plans, health systems, and provider groups to support patients with, or at risk of developing, cardio, kidney, metabolic, or other chronic conditions.

We hire the brightest and boldest — talent driven by purpose and impact. Since our founding in 2016, our growth trajectory isn’t just a milestone — it’s a signal. Our leadership values culture and leads with intention as we remain dedicated to driving clinical excellence.

Does this sound like you? Keep reading.

How We’ll Support You:
We offer 25+ health, growth, and wealth work perks to help teammates be the best version of themselves, including:

• Subsidized personal healthcare coverage: Medical, Dental & Vision, plus Wellness programs
• Paid Time Off: Accrual of 3 weeks’ Vacation (PTO)
• Professional development: CEU and tuition reimbursement

The Patient Health Advocate, Field (PHA) plays an essential role on the interdisciplinary care team and are responsible for outreach to members to inquire about current health conditions and act as an advocate guiding them through their care needs operating in a hybrid telehealth model that blends remote work with in-person visits to members’ homes, healthcare providers, and clinical facilities to meet the needs of the patient. The PHA will work as an extension of the clinical care team and will obtain and review data and coordinate care with the clinical team as members’ conditions change.  Patient Health Advocates assist members with health care appointment scheduling and locating local resources to assist with member needs. PHA’s will facilitate connecting patients to various members of the health care team as well as PCP’s, nephrologists, and other health care providers as needed, based on the patients’ needs. The PHA will also be involved in the community to help connect patients with additional resources.

• Manage caseload through in-person and/or telephonic and electronic means of communications and coordination, dependent on business processes or according to clinical workflows.

• Establish trusting relationships with patients & caregivers and identify innovative strategies to improve and maintain engagement. 

• Coordinate care by serving as the advocate and resource for the patient, their family, and their provider(s).

• Document pertinent patient information and Care Management Plan in Electronic Health Record and Care Management Systems as appropriate.

• Engages with patients who need assistance with self-care needs in addition to what a nurse care manager can provide via phone, including:

• Address language and cultural barriers to care management and self-care.

• Act as an extension of the nurse to coach and guide the patient to meet both personal and health care goals.

• Schedules provider and or diagnostic testing appointments on behalf of patients.

• Attend patient appointments when needed.

• Remind patients of their upcoming appointments.

• Help patients access community and government-based services and assisting filling out paperwork for the patient when needed.

• Reinforce the care plan with patients and caregivers as needed.

• Arrange transportation as needed.

• Assist patients with enrolling in educational videos to support their care needs.

• Participate in the integrated care team meetings.

• Conduct telephonic outreach to members within designated geographic area to introduce the Somatus program and encourage enrollment.

• Facilitate transition of care activities

• Conduct door-to-door engagement outreach for patients with telephonic barriers. Support care team members through facilitating in home telehealth visits with patients, meet members in home/facility/hospital to support care as needed.

• Utilize motivational interviewing techniques to encourage patients to make behavioral changes.

• Meet role performance and quality goal metrics

• Perform care management activities as required in operational workflows.

Qualifications:

• High school diploma or equivalent required.
• 1+ years of experience in case management or care management, preferably coordinating care across multiple settings.
• 2+ years healthcare related experience.
• Experience working with Medicare, Medicaid, and/or Special Needs populations.

Preferred Qualifications:

• Medical Assistant, Licensed Practical Nurse, Patient Care Technician, Engagement Specialist, Community Health Worker Experience, or exposure to renal patients.
• Bilingual in either Spanish, Cantonese, or Mandarin with the ability to converse fluently in a clinical setting using clinical terms.

Knowledge, Skills, and Abilities:

• Demonstrated success in working as part of a multi-disciplinary team, including communicating and working with Physicians and Registered Nurses.

• Effective written and verbal communication skills that demonstrate respect and cultural awareness during interactions with patients and clients.

• Computer proficiency utilizing MS Office (Word, Excel, PowerPoint and Outlook), and telecom devices including the ability to type and talk at the same time while navigating multiple applications.

• Ability to obtain valid BLS certification from a licensed American Heart Association or American Red Cross training facility as needed.

• Proven experience with engaging patients in making healthy behavior changes.

• Proven skills in navigating the health systems and making necessary linkages to meet specific needs.

• Ability to consult with physicians and other team members to ensure that care plan is successfully implemented

• Participate actively in assigned Care Management Coordination Committee (CMCC) meetings

• Core values consistent with a patient-centered approach to care

• Ability to adapt to changing work environment based on member and client needs

• Adheres to departmental policies and procedures

• Self-motivated with a strong work ethic

Physical Requirements:

• Reside in a location that can receive a high-speed internet connection or can leverage existing high-speed internet service.

• Access to private dedicated home workspace free from distractions to protect patient privacy regarding HIPAA and Privacy regulations.

• Ability to travel throughout the assigned region to conduct home, provider, or facility visits, depending on the assigned market needs. All work-related travel is eligible for mileage reimbursement and travel expense coverage in accordance with company policy.

• Ability to work a full time assigned schedule to meet patient and client needs.

• Ability to remain in a seated or standing position for extended periods of time as required to perform essential job functions.

Compensation:

$22.00 to $26.00 per hour

We offer competitive compensation that reflects market conditions and recognizes the skills, experience, and contributions of our team members. Compensation for the role will depend on a number of factors, including a candidate’s qualifications, skills, competencies, experience, and geographic location and may fall outside of the range shown above.

This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the employee. Duties, responsibilities, and activities may change at any time with or without notice. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Our priority is the health and safety of our members, colleagues, partners, and community. For this position, we require proof of COVID-19 vaccination, annual Influenza vaccination, along with immunizations for Hepatitis, MMR, Varicella, Tdap, and TB for employment.