Quality Behavioral Health Advocate

Centene Corporation • Remote-FL, FL

4d • $27 - $49 • Remote

About The Position

The Quality Behavioral Health Advocate works with members and providers to close behavioral health care gaps, remove barriers to care, and improve member and provider experience through targeted outreach. The position supports behavioral health quality improvement interventions and helps address deficiencies affecting compliance with state and federal HEDIS standards. It conducts telephonic outreach to Medicaid members recently discharged from the Emergency Room or Emergency Department and to members identified as needing behavioral health services, providing education and coaching about care gaps and barriers to care.

The advocate serves as a liaison and member advocate among members and their families, physicians, facilities, and agencies. The role helps members connect with behavioral health providers, finds providers when needed, schedules appointments, and arranges transportation and other wraparound services, including connections to community resources and affinity programs. It documents member contacts, coordinates with other departments to resolve issues, and refers members to case or disease management when appropriate.

The role also acts as a team lead and subject matter expert, supporting colleagues through coaching and training, audits and chart reviews, reports and data extracts, special projects, and implementation of new quality improvement and HEDIS initiatives. It may represent the supervisor in meetings and assignments, help improve departmental processes, and participate in community and organizational quality improvement meetings. The position is remote/work from home, and applicants must reside in Florida and hold an active, current, unrestricted behavioral health license specified in the posting. The role requires a master's degree in Behavioral Health or Social Work, or a degree from an accredited school of nursing, along with 2–4 years of related experience. The listed pay range is $27.02–$48.55 per hour.

Requirements

• Master's degree in Behavioral Health or Social Work, or a degree from an accredited school of nursing.
• 2–4 years of related experience.
• Licensed Master's Behavioral Health Professional (for example, LCSW, LMSW, LMFT, LMHC, or LPC), or RN based on state contract requirements, with behavioral health experience.
• For this Florida role, reside in Florida and hold an active, current, unrestricted LCSW, LMFT, LMHC, or LPC license.
• Ability to maintain confidentiality of business and protected health information.

Responsibilities

• Conduct telephonic outreach and health coaching to members, including Medicaid members recently discharged from the Emergency Room/Emergency Department, to support quality improvement and regulatory and contractual requirements.
• Close FUH, FUM, and FUA HEDIS care gaps with identified members.
• Educate members and their families about identified care gaps and barriers to care.
• Help members connect with behavioral health providers or find a provider for ongoing services.
• Schedule doctor and behavioral health appointments and arrange follow-up appointments as needed.
• Arrange transportation and connect members with community-based resources, wraparound services, and affinity programs as available.
• Act as a liaison and advocate among members and families, physicians, facilities, and agencies.
• Document all actions regarding member contact.
• 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 supporting the department.
• Serve as a subject matter expert on departmental best practices, reports, and data extracts.
• Lead preparation and submission of projects, reports, and assignments supporting department initiatives.
• Assist with implementation of new and expanding healthcare quality improvement and HEDIS initiatives.
• Represent the supervisor in meetings or on special assignments and act as a team lead and information resource in the supervisor's absence.
• Coach and train new and current Quality Behavioral Health Advocates.
• Help establish and implement process improvements and departmental best practices.
• Conduct audits and chart reviews of fellow Quality Behavioral Health Advocates to ensure best practice and proper protocol.
• Participate in and represent the plan at community, health department, collaborative, and other organizational meetings focused on quality improvement.
• Maintain confidentiality of business and protected health information.
• Comply with all policies and standards and perform other duties as assigned.

Benefits

• Competitive pay
• Health insurance
• 401K
• Stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work schedules, including remote, hybrid, field, or office schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level