Patient Care Advocate

Centene Management Company • Kalamazoo, MI

17h

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 to improve HEDIS measures, provides education on HEDIS measures and coding, and supports quality improvement interventions and audits related to plan providers. The advocate 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 face-to-face education to members and their families about identified care gaps and barriers. The role schedules appointments, arranges transportation and follow-up, connects members with community resources and available affinity programs, and documents member contacts and actions. The advocate serves as a liaison among members and families, physicians, and facilities or agencies, and as WellCare's representative in the provider community. The position requires residence in Michigan and some travel within and near Kalamazoo.

The role also assesses provider performance data, develops improvement opportunities, collaborates with Provider Relations on quality, risk adjustment, and operations (claims and encounters), coordinates with other departments to resolve member issues, and refers members to case or disease management when appropriate. The advocate completes special assignments, performs other duties as assigned, and complies with all policies and standards while maintaining the confidentiality of business and protected health information.

Requirements

• Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related health field, or equivalent work experience; four years of total experience is required for the position.
• At least two years of work experience in direct patient care, social work, quality improvement, or health coaching; managed care experience is preferred.
• Must reside in the state of Michigan.
• A driver's license is required for the Michigan plan.
• Maintain confidentiality of business and protected health information.

Nice To Haves

• Experience in direct patient care, social work, quality improvement, or health coaching in a managed care environment.
• One of the following licenses or certifications is preferred: 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 the member and provider experience.
• Collaborate with providers in the field to improve HEDIS measures and educate practices on HEDIS measures and HEDIS ICD-10/CPT coding in accordance with NCQA requirements.
• Support quality improvement interventions and audits related to plan providers and help resolve deficiencies affecting compliance with State and Federal HEDIS standards.
• Conduct telephonic outreach and health coaching to members identified as needing preventive services in support of quality, regulatory, and contractual requirements.
• Provide face-to-face education to members and their families in provider offices about identified care gaps and barriers to care.
• Schedule doctor appointments for members with care gaps and arrange transportation and follow-up appointments as needed.
• Connect members with community-based resources and available affinity programs.
• Serve as a liaison and member advocate among members and families, physicians, and facilities or agencies.
• Represent WellCare in the provider community and in provider offices where services are embedded.
• Assess provider performance data to identify and strategize provider improvement opportunities.
• Collaborate with Provider Relations to improve provider performance in quality, risk adjustment, and operations, including claims and encounters.
• Document all actions taken regarding contact with members.
• Interact 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.

Benefits

• Competitive pay
• Health insurance
• 401K
• Stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules
• Additional forms of incentives may be included in total compensation, subject to program eligibility.

What This Job Offers

• Job Type: Full-time