Patient Care Advocate

Centene Corporation•Kalamazoo, MI

22h•$27 - $49

About The Position

The Patient Care Advocate works with members and providers to close care gaps, remove barriers to care, and improve member and provider experiences through outreach and face-to-face interactions at large IPA and group practices. The role collaborates with providers in the field, supports improvement of HEDIS measures, and educates provider practices on HEDIS measures and coding. It also supports quality improvement interventions and audits related to plan providers and helps resolve deficiencies affecting compliance with state and federal HEDIS standards. Embedded in provider offices, the advocate conducts telephonic outreach to members identified as needing preventive services and provides education about their care gaps during medical appointments. The role schedules doctor appointments and helps arrange wraparound services, including transportation and connections to community resources and affinity programs. The advocate maintains confidentiality of business and protected health information and serves as a liaison among members and families, physicians, and facilities or agencies. The position requires residence in Michigan and some travel within and near Kalamazoo.

Requirements

Reside in the state of Michigan.
Some travel within and near Kalamazoo is required.
A bachelor's degree in healthcare, public health, nursing, psychology, social work, health administration, or a related health field, or equivalent work experience; a total of 4 years of experience is required for the position.
At least 2 years of work experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.
A driver's license is required for the Michigan plan.

Nice To Haves

Preferred license or certification: Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN).

Responsibilities

Act as a liaison and member advocate between members and families, physicians, and facilities or agencies.
Represent WellCare in the provider community and work with provider and office staff at practices where services are embedded.
Advise and educate provider practices on appropriate HEDIS measures and HEDIS ICD-10/CPT coding in accordance with NCQA requirements.
Assess provider performance data to identify and strategize opportunities for provider improvement.
Collaborate with Provider Relations to improve provider performance in quality, risk adjustment, and operations, including claims and encounters.
Schedule doctor appointments for members with care gaps to access needed preventive services and close care gaps in provider offices.
Educate members and their families face-to-face in provider offices about identified care gaps and barriers to care.
Conduct telephonic outreach and health coaching to support quality improvement and regulatory and contractual requirements.
Arrange transportation and follow-up appointments for members as needed.
Document actions taken regarding contact with members.
Work with other departments, including customer service, to resolve member issues.
Refer members to case or disease management as appropriate.
Complete special assignments and projects instrumental to the department's function.
Perform other duties as assigned and comply with all policies and standards.
Maintain confidentiality of business and protected health information.