Care Coordination Advocate New

Clearwaterhealth; Town of Texas (WI); Remote; USD 10,000 - 60,000; Full time

Job summary

Clearwaterhealth is seeking a Care Coordination Advocate to collaborate with members and providers, ensuring effective navigation within healthcare systems. Key responsibilities include reviewing patient cases, coordinating appointments, and fostering strong relationships while complying with HIPAA regulations. This fully remote role offers competitive pay and extensive benefits.

Benefits

Unlimited PTO

401K match

Work from home reimbursement

Qualifications

• Minimum of 2+ years in healthcare administration.
• 1+ years in Advocacy or Case Management preferred.
• Strong communication of medical terminology.

Responsibilities

• Review new cases for eligibility and benefits.
• Coordinate member's care and appointments.
• Negotiate provider contracts.

Skills

Communication

Organizational Skills

Customer Service

Education

Experience in Healthcare Administration

Experience in Advocacy, Prior Authorization or Case Management

Tools

Microsoft Office

Salesforce

Job description

As a Care Coordination Advocate, you will play a crucial role in working collaboratively with our members, providers and internal Clearwater teams to guide members through their experience while accessing healthcare. Advocates playTHE key role in coordinating member/patient care and delivering exceptional, thorough service. Reporting directly to the Manager of Care Coordination, you will perform the key administrative day-to-day operations of the department and ensure seamless communication and collaboration within the team. You will work closely with other Advocates, Bridge Department, Nurse Case Managers, members and providers on your assigned cases.

Role Responsibilities:

• Review new cases for eligibility and qualifying benefits
• Coordinate members care/appointments with the member, provider and our preferred vendors
• Daily communication with members on the status of their case
• Update cases on an as needed basis
• Negotiate and establish Letters of Agreement (LOA), Single Case Agreements (SCA), Cash Pay Rates or Provider Contracts
• Assist and work closely with the Nurse Case Manager in managing member’s cases on a medical appropriateness level on an ongoing basis and providing support where needed
• Work Provider Nominations to establish LOA’s with the nominated provider
• Review plan information, treatment and care, provider status etc. with Tier 2 members prior to their enrollment
• Review and negotiate post-service cases (balance bills) that are submitted by members
• Develop and maintain strong collaborative relationships with internal teams, members, and providers
• Minimum of 2+ years of experience in the healthcare administration field
• 1+ years of experience in Advocacy, Prior Authorization or Case Management preferred
• Prior experience in a clinical setting is preferred
• Experience in team management is highly desirable
• Experience with Microsoft Office or similar
• Familiarity with Salesforce systems is advantageous
• Ability to communicate medical terminology and processes clearly to patients
• Strong organizational skills and ability to thrive in a fast-paced environment
• Excellent communication and customer service skills required
• Demonstrated ability to maintain accurate and up-to-date documentation in systems
• Thorough understanding of HIPAA regulations and commitment to maintaining patient confidentiality
• Strong prioritization skills, with the ability to manage multiple responsibilities effectively
• Proficiency in both verbal and written communication; bilingual skills are advantageous
• Passionate about fostering strong relationships with internal teams, members, and providers
• Legally authorized to work in the US

All new hires must successfully pass a background screening as part of the onboarding process.

The compensation for this position depends on experience, skills, qualifications, location, and competencies. We are a remote first organization with employees in 25 states and 5 countries and growing! We offer competitive compensation, bonus’, and benefit packages, PTO (unlimited or 3 weeks accrued depending on the role) as well as a 401K match and regularly review these to align with industry standards. We also offer new employees a one time work from home reimbursement to set up your home office.

Pay Range

$26 - $28 USD

About Us:

Better plans, better benefits, and better prices. Clearwater is a cutting edge InsurTech company headquartered in Austin, TX, the city known for its unicorns, tech giants, food scene, weirdness, and never-ending heat. Our team of innovators, operators, and healthcare veterans were determined to drive major change in our industry, once and for all. Whether you are seeking benefits as an individual, your family, or your business, we have the right plan, at the right price, with total transparency—even if it’s not one of our exclusive offerings.

We are committed to fostering an inclusive environment where all employees feel valued, respected, and supported. We actively promote diversity in all its forms and strive to create equitable opportunities for everyone regardless of race, ethnicity, gender, sexual orientation, age, disability, religion, or any other characteristic protected by law.

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