Patient Care Advocate

This is a fully remote position, open to applicants in Iowa.

📋 Description

• Collaborate with members and providers to address care gaps and eliminate barriers to care.

• Enhance member and provider experience through outreach and in-person interactions.

• Partner with providers in the field to educate them on HEDIS measures and proper coding practices.

• Assist in the implementation of quality improvement strategies and conduct provider audits.

• Aid in resolving deficiencies that impact compliance with State and Federal HEDIS standards.

• Perform telephonic outreach and health coaching for members located in provider offices.

• Inform members and their families about identified care gaps and barriers to care.

• Arrange doctor appointments and coordinate transportation, follow-up visits, community resources, and affinity programs.

• Act as a liaison and advocate for members and families, communicating effectively with physicians, facilities, and agencies.

• Represent Centene/WellCare within provider communities.

• Evaluate provider performance data to identify areas for improvement.

• Collaborate with Provider Relations on Quality, Risk Adjustment, Operations, claims, and encounters.

• Document all interactions related to member contact.

• Work with customer service and other departments to resolve member concerns.

• Refer members to appropriate case or disease management services as necessary.

• Complete special projects and additional tasks as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• This is a remote opportunity for residents of Iowa.

• A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related health field, or equivalent work experience is required.

• A total of 4 years of experience is necessary for this position when considering equivalent work experience.

• At least 2 years of experience in direct patient care, social work, quality improvement, or health coaching is required.

• Experience in a managed care setting is preferred.

• One of the following credentials is preferred: Licensed Practical Nurse (LPN), Licensed Master Social Worker (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN).

• Must uphold the confidentiality of business and protected health information.

• For the Michigan plan only: A valid driver's license is required.

🏝️ Benefits

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement program.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Competitive salary.

• Additional incentives may be included in the total compensation package.

• Equal opportunity employer dedicated to promoting diversity.