Patient Care Advocate

Centene Corporation•Remote-IA, IA

16h•$27 - $49•Remote

About The Position

The Patient Care Advocate (PCA) 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 interaction, including work embedded in large IPA and group provider practices. The PCA collaborates with providers to improve HEDIS performance, provides education on HEDIS measures and coding, supports quality improvement interventions and audits, and helps resolve deficiencies affecting compliance with state and federal HEDIS standards. The role also conducts telephonic outreach to members who need preventive services and educates members about care gaps during provider visits. The PCA schedules appointments and helps arrange transportation, follow-up care, community resources, and other available support programs. The position maintains the confidentiality of business and protected health information. The PCA serves as a liaison and advocate among members and their families, physicians, and facilities or agencies, and represents WellCare within provider practices. The role assesses provider performance data, collaborates with Provider Relations and other departments, documents member contacts, refers members to case or disease management when appropriate, and completes departmental projects and other assigned duties. The opportunity is remote for Iowa residents.

Requirements

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 four years of experience is required for the position; the posting specifies that two or more years of work experience should be in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.
For Michigan plan applicants, a driver's license is required.

Nice To Haves

Experience in direct patient care, social work, quality improvement, or health coaching in a managed care environment.
One of the following preferred credentials: Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN).

Responsibilities

Work with members and providers to close care gaps, remove barriers to care, and improve member and provider experiences.
Serve as a liaison and advocate between members and families, physicians, and facilities or agencies.
Represent WellCare in provider practices and collaborate with provider office staff.
Educate provider practices on HEDIS measures and HEDIS ICD-10/CPT coding in accordance with NCQA requirements.
Assess provider performance data and 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.
Support quality improvement interventions and audits related to plan providers and help address deficiencies affecting HEDIS compliance.
Conduct telephonic outreach and health coaching to members identified as needing preventive services.
Provide face-to-face education to members and families about care gaps and barriers to care during provider-office visits.
Schedule doctor appointments for members with care gaps to access preventive services.
Arrange transportation and follow-up appointments as needed, and connect members with community resources and other available support programs.
Document actions taken regarding member contacts.
Interact with departments, including customer service, to resolve member issues.
Refer members to case or disease management when appropriate.
Complete special assignments and projects instrumental to the department and perform other duties as assigned.
Maintain confidentiality of business and protected health information.
Comply with all policies and standards.