Quality Care Advocate

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

📋 Description

• Act as an essential bridge between members and the healthcare system, aiming to enhance health outcomes by identifying and addressing care gaps.

• Engage with community members to pinpoint care gaps and connect them with suitable healthcare services and resources.

• Conduct home visits or community-based assessments to assess member needs and identify social determinants of health.

• Facilitate care coordination efforts.

• Assist members in navigating complex healthcare and social service systems.

• Support members with appointment scheduling, understanding care plans, and accessing benefits or entitlements.

• Collaborate with providers to share quality performance data, including HEDIS and CAHPS, and aid in improvement initiatives.

• Provide education to members on preventive care, management of chronic conditions, and available community resources.

• Record member interactions, care gap closures, and referrals in the designated systems.

• Partner with Quality, Care Management, Provider Relations, and other internal departments.

• Monitor and report on the effectiveness of outreach efforts and care gap closure metrics.

• Ensure compliance with state and federal regulations as well as organizational policies.

• Participate in seasonal campaigns and quality initiatives.

• Build relationships with local organizations and stakeholders, serving as a community ambassador.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be a resident of Texas.

• Bachelor's Degree in Social Work, Public Health, Nursing, or a related field; or equivalent experience is required.

• A minimum of 2 years of experience in community health or healthcare quality is required.

• Experience working with health plan members and navigating community resources is essential.

• Knowledge of Medicaid / Medicare programs and quality measures (e.g., HEDIS) is required.

• Excellent communication and interpersonal skills are necessary.

• LCSW - Licensed Clinical Social Worker is preferred.

• RN - Registered Nurse - State Licensure and/or Compact State Licensure is preferred.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off in addition to holidays.

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