How to Become a Patient Advocate or Navigator

What Makes a Good Patient Advocate

Advocates who will assist patients through diagnosis and treatment of disease—whether that means helping them coordinate with medical professionals, working with them to make treatment choices, or even helping them find the right doctors to help them—may need a background in health and medicine, as a doctor, nurse or other medical profession.

Advocates who wish to provide medical, home health or eldercare forms of assistance will need to be people-oriented and have plenty of patience.

Those who wish to work with the elderly or with very young children will need the patience and appreciation of those age groups.

Those who prefer the insurance and billing aspects of advocacy will need to understand how payer reimbursements work, plus co-pays, co-insurance, and deductibles. An understanding of government payment systems such as Medicare and Medicaid, plus basic math skills are also important.

To be an entrepreneur patient advocate and start your own patient advocacy business, you'll need to understand business basics.

In addition, the best patient advocates need to be politely assertive, and able to both provide respect and command respect from the many others involved in a patient's care.

Businesses and Organizations That Hire Patient Advocates to Work for Them

Patient advocates have the opportunity to work in many different settings.

Work for a hospital, rehab center, or other facilities that hire patient advocates. Many have a customer-service type position. Some of these advocates have a background in social work or other forms of customer service. While they do trouble-shoot and solve problems for patients, many of their decisions must be made in favor of the facility and not necessarily in the best interest of the patient.

Work for an insurance company, usually an HMO (Health Maintenance Organization). Some of the managed care-type healthcare payer systems employ advocates. They may be called "patient advocates" or "case managers." These advocates manage navigation of the system for difficult medical cases. Their primary job is to save the payer money, but they may also be helpful to patients who are having trouble figuring out where to turn.

Work for a government entity. Patient advocates or case managers work for state health systems usually in nursing, or social work/human resources capacity. Most of the support is provided to patients who rely on Medicare, Medicaid, or other state-run systems to pay for their healthcare.

Work for yourself. Start a patient advocacy business. Beyond needing patient advocacy skills, starting your own patient advocate business will call on additional attributes and skills that you may find wonderfully rewarding. There are specific steps to take related to building a successful patient advocacy business.

Patient Advocates Who Work Directly for Patients

Sometimes the patient or his family is, in effect, the employer. The patient may hire an individual or a business to represent him through medical, insurance, or legal situations. Because the patient advocate works directly for the patient, the advocate's allegiance can be focused on the patient.

Work for a patient-focused organization. There are organizations that focus on healthcare, insurance, and payment system problems, even placement in rehab or nursing homes. They are private or not-for-profit organizations that work for a fee paid by the patient or his family. These organizations have begun to play a much larger role in the healthcare landscape and it won't be long before they become a part of the mainstream healthcare in the U.S.

Work for an individual patient, paid by the patient or by the patient's family. These advocates help those having trouble navigating the healthcare system who either can't get diagnosed or can't find the proper treatment. Some of these advocates work on insurance problems helping to find payment resources or helping patients navigate their payment systems. They may be hired by family members who live too far away to provide support to a sick loved one, or who need a caregiver for their loved one who is ill because they are away at work all day.

Most advocates who work for individuals are self-employed entrepreneurs. Some of these entrepreneurs are building advocacy businesses and may hire additional advocates to work with them, in order to serve more patients.

Credentials Needed

Because paid patient advocates are so new to healthcare, there are few formal degrees or credentialing programs available. Most patient advocates are self-proclaimed, coming from backgrounds varying from nursing or other healthcare professions to social work or education. Some patient advocates have simply gained on-the-job experience helping a loved one navigate the system, and now they hope to expand that experience into a career helping others.

The existing health and patient advocacy programs are available mostly for those wishing to receive a master's degree, or for medical students who wish to add advocacy as an adjunct to their medical degrees. More recently, online programs have been developed, too.

Case managers may earn a credential that can be earned through a combination of education and testing. Most case managers have nursing degrees or social work degrees, to begin with, then take a test that makes them eligible for jobs that require the case manager credential. Most are employed with managed care/HMO (health management organizations), or by government entities to work directly with patients.

Furthermore, a certification from the Patient Advocate Certification Board has been available since March 2018.

What Else You Need to Know

Patient advocacy is an up-and-coming career, and those who take the time to educate themselves and build their skills and experience will be rewarded with both a solid career and possibly an excellent income. So, what else do you need to know if you want to be a patient advocate?

Patient advocates who wish to be self-employed will want to understand what it takes to build a patient advocacy business, and readily know the answers to the questions potential patient-clients will ask. You may be the best advocate in the world, but if you can't answer these questions about your business, patients will move on to hire someone else.

Finally, because the concept of patient advocacy is so new, and because there are so many hurdles faced while trying to navigate the current American healthcare system, patient advocates may be surprised to learn they are not always welcome or received well by medical providers.

Those advocates who choose to work for hospitals and other facilities may find frustrated patients and pressure from their employers to cut their advocacy efforts short if it becomes too expensive to serve the patient.

These hurdles can often be overcome using excellent communication skills—which is why they are so necessary for professional advocates. They should not dissuade someone with the knowledge and willingness to be a patient advocate from giving this very rewarding career a try.