Patient Care Specialist

Relation Insurance is a leading, innovative company with a strong commitment to excellence and a passion for delivering cutting-edge solutions to our clients. As a key player in the insurance market, we pride ourselves on our dynamic culture, collaborative environment, and continuous drive for success. With a rich history and a bright future ahead, we are looking for exceptional individuals to join our team and contribute to our ongoing growth and success.
 

WHAT WE’RE LOOKING FOR

The Patient Care Specialist serves as the primary point of contact for members participating in the company’s Center of Excellence Program, delivering high-touch care coordination and support throughout the healthcare journey. The individual in this role manages patient logistics, facilitates access to care, and ensures a seamless, patient-centered experience. The Specialist exercises independent judgment to prioritize caseload activities, remove barriers to care, and support informed decision-making. The individual in this position plays a key role in driving positive patient outcomes and program performance.

A GLIMPSE INTO YOUR DAY

• Serves as a primary liaison for prospective and enrolled patients, providing expert guidance on program offerings, care pathways, benefits and available resources.

• Manages a complex patient caseload, prioritizing outreach, coordinate care progression, and ensure continuity across the patient experience.

• Manages end to end logistics for program participants, including travel arrangements, scheduling, and vendor coordination, while resolving real-time issues impacting care delivery.

• Facilitates referrals, program enrollments, and access to Center of Excellence providers to ensure timely and appropriate care.

• Advocates for patients by assessing individual needs, resolving barriers to care, and supporting informed decision-making throughout the care journey.

• Maintains accurate compliant documentation of patient interactions, care coordination activities, and case outcomes in accordance with organizational policies and regulatory requirements.

• Resolves escalated patient, provider and vendor issues through independent judgment and problem-solving.

• Optimized and implemented care pathways and program processes to support departmental and organizational clinical and financial goals.

• Collaborates cross-functionally with clinical, operational, and vendor partners to support integrated care delivery, enhance patient engagement strategies, and improve overall program effectiveness.

• Evaluates and confirms ongoing patient eligibility by interpreting program criteria and helping patients maintain access to applicable benefits and services.

• Accountable for achieving program performance metrics, patient satisfaction outcomes, and operational goals.

• Identifies process improvement opportunities and contributes to program development, workflow optimization, and operational enhancements.

• Leverages technology, care management platforms, and proprietary AI tools to enhance patient engagement, streamline coordination activities, and improve program outcomes.

•  Special projects and other duties as assigned.

WHAT SUCCESS LOOKS LIKE IN THIS ROLE

• High School diploma or equivalent required.

• A minimum 5 years’ experience in patient engagement, care coordination, population health, or member outreach roles.

• Prior experience in healthcare operations within a specialized, high-volume, high-acuity patient care environment.

• Deep understanding of clinical programs, care pathways, and health plan operations, enabling you to educate and empower patients.

• Demonstrated ability to manage caseloads, prioritize competing demands, and resolve complex patient or provider issues. Strong interpersonal skills with the ability to build trust and effectively engage diverse patient populations.

• Strong problem-solving abilities, organizational skills, and accountability, thriving both independently and as part of a collaborative team.

• Computer literate with a strong knowledge of Microsoft Office products and the ability to learn new software/systems.

• Proficiency with telephonic and virtual engagement platforms, care management software, and secure messaging tools.

• Demonstrated empathy, active listening, and a patient-centered approach in all interactions.

• Knowledge of HIPAA and health plan regulatory requirements.

• Flexibility to support patients outside of standard business hours as needed.

WHY CHOOSE RELATION?

• Competitive pay.

• A safe and healthy work environment provided by our robust benefit program including family health and wellness programs, 401K, employee assistance programs, paid time off, paid holidays and more.  

• Career advancement and development opportunities.