Location
India / Philippines (Onsite and/or Remote)
Reporting To
Care Coordination Lead / Operations Manager
Role Overview
The Clinical Care Coordination Advocate is responsible for conducting structured post-discharge patient assessments using standardized risk-scoring tools to identify readmission risk and support timely care escalation.
In addition to post-discharge risk assessment, this role is designed to support broader clinical care coordination functions as program needs evolve. These functions may include clinical data entry, management of standardized assessments, documentation of clinical findings in member platforms, and proactive communication with care management teams.
This role requires clinical literacy without clinical practice, strong assessment accuracy, and strict adherence to defined scoring protocols. The position is non-diagnostic and supports downstream care management and utilization workflows for US healthcare programs.
This is a high-accuracy, quality-critical role supporting post-acute and transitional care programs.
Key Responsibilities
Post-Discharge Risk Assessment & Scoring
- Conduct structured post-discharge assessments using standardized questionnaires and scoring frameworks
- Accurately map patient responses to predefined risk categories and point values
- Apply cumulative risk logic to identify low-, moderate-, and high-risk patients
- Ensure strict adherence to assessment scripts and scoring rules
Clinical Risk Interpretation (Non-Diagnostic)
- Demonstrate working knowledge of common post-acute risk factors including:
- Chronic conditions (CHF, COPD, diabetes, renal disease, infections)
- Recent hospitalizations or emergency department utilization
- Medication adherence challenges
- Functional, behavioural, or social risk indicators
- Identify risk patterns requiring escalation per program guidelines
Expanded Clinical Support & Data Management (As Program Needs Evolve)
Enter structured clinical data into designated member or care-management platforms
Upload and document standardized clinical assessments (e.g., post-discharge assessments, screenings, care coordination tools)
Ensure accurate linkage of assessment results to the correct member record
Generate alerts, flags, or notifications to case managers or nursing teams based on predefined triggers
Support longitudinal documentation of member status across episodes of care
Adapt to additional standardized assessments or workflows as new programs are introduced
Care Escalation & Routing
- Trigger escalation flags in accordance with defined care-management protocols
- Route high-risk cases to nursing or care-management teams in a timely manner
- Support accurate handoffs with complete and compliant documentation
Documentation & Quality Compliance
- Maintain complete, accurate, and audit-ready documentation
- Ensure assessment data integrity and consistency across systems
- Adhere to HIPAA and all applicable US healthcare data privacy regulations
- Meet defined quality, accuracy, and productivity benchmarks
Patient Interaction & Communication
- Engage patients professionally and empathetically during post-discharge outreach
- Ask sensitive health-related questions clearly and without leading
- Maintain calm, patient-centred communication aligned with scripted workflows
Required Experience & Qualifications
Must-Have
- 36+ years of experience in US Healthcare Operations
- Prior experience in care coordination, population health, utilization management, or post-discharge programs
- Strong clinical literacy and working knowledge of medical terminology
- Experience using structured assessments, questionnaires, or scoring tools
- Clear spoken English and professional communication skills
- Comfort working in healthcare platforms or documentation systems
Good to Have
- Nursing or allied health background
- Experience in transitional care, readmission reduction, or care-management programs
- Familiarity with healthcare documentation or care-management platforms
- Prior experience in healthcare BPOs supporting payer or provider programs
- Experience entering or managing clinical data within care-management or member platforms
Key Competencies
- Clinical literacy without clinical practice
- High attention to detail and process discipline
- Risk stratification and judgment within defined protocols
- Empathy and sensitivity toward post-acute and elderly populations
- Time management and SLA adherence
- Strong documentation and compliance orientation
Work Expectations
- Comfortable working in a structured, assessment-driven environment
- Ability to manage patient interactions alongside documentation requirements
- Flexibility during peak volumes or program audits
- Mandatory completion of HIPAA and program-specific compliance training
- Willingness to cross-train on additional standardized clinical workflows as programs expand
Career Path
- Senior Clinical Care Coordination Advocate
- Clinical Care Coordination SME / Quality Reviewer
- Clinical Care Coordination Lead / Manager
- Expanded Clinical Operations or Population Health Support Roles
