Patient Care Advocate

About This Role

Providing support to members and healthcare providers to improve the overall patient experience is the core of this role. This involves removing barriers to care, closing care gaps, and interacting directly with members and providers in large IPA and group practices. The advocate collaborates with providers to improve HEDIS measures and educates on HEDIS measures and coding.

Responsibilities

• Work with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction
• Collaborate with providers in the field to improve HEDIS measures and provide education for HEDIS measures and coding
• Support the implementation of quality improvement interventions and audits in relation to plan providers
• Assist in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS
• Conduct telephonic outreach, while embedded in the providers' offices, to members identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements
• Provide education to members regarding care gaps when in the providers' office for medical appointments
• Schedule doctor appointments on behalf of the practitioner and assist members with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available
• Maintain confidentiality of business and protected health information
• Act as a liaison and member advocate between the member/family, physician and facilities/agencies
• Act as the face of WellCare in the provider community with the provider and office staff where services are embedded
• Advise and educate provider practices in 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 areas of Quality, Risk Adjustment, Operations (claims and encounters)
• Schedule doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office
• Conduct face-to-face education with the member and their family, in the provider’s office, about care gaps identified and barriers to care
• Conduct telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements
• Arrange transportation and follow-up appointments for members as needed
• Document all actions taken regarding contact related to member
• Interact with other departments including customer service to resolve member issues
• Refer to case or disease management as appropriate
• Complete special assignments and projects instrumental to the function of the department
• Perform other duties as assigned
• Comply with all policies and standards

Requirements

• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience (a total of 4 years of experience required for the position)
• 2+ years of work experience in direct patient care, social work, quality improvement or health coaching, preferably in a managed care environment
• Must reside in the state of Michigan
• Driver's license required (for Michigan plan only)

Nice to have:

• Licensed Practical Nurse (LPN)
• Licensed Master Social Work (LMSW)
• Certified Social Worker (C-SW)
• Licensed Social Worker (LSW)
• Licensed Registered Nurse (RN)

Benefits

• Health insurance
• 401K and 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

Important Details

• Some travel required within and near Kalamazoo

About the Company

Centene connects people to the care they need to live healthier lives. The company offers meaningful challenges that directly support individuals, families, and communities, building skills while making healthcare more accessible and effective.