Care Navigator: Close Care Gaps & Improve Access

Professional Management Enterprises (PME); Indianapolis (IN); On-site; USD 42,000 - 54,000; Full time

Job summary

WellCare in Indianapolis is seeking a Patient Care Advocate to work with members and providers to close care gaps and improve the member and provider experience. You will educate practices on HEDIS measures and assist with scheduling and wraparound services during provider visits.

The role involves telephonic outreach and in-office education, collaborating with provider relations to enhance quality and regulatory compliance, and maintaining confidentiality of patient information while

Qualifications

• Bachelor's degree or equivalent with 4 years in direct patient care, social work, quality improvement or health coaching.
• Experience in managed care environment preferred.
• Knowledge of NCQA HEDIS measures and ICD-10/CPT coding.
• Ability to schedule appointments and coordinate transportation and wraparound services.

Responsibilities

• Acts as liaison between member/family, physician and facilities.
• Represents WellCare in provider community in coordination with staff.
• Educates providers on HEDIS measures and coding per NCQA requirements.
• Assesses provider performance data to identify improvement opportunities.
• Collaborates with Provider Relations to improve quality and operations.
• Schedules patient appointments to close care gaps for preventive services.
• Performs face-to-face education with members and families in offices.
• Conducts telephonic outreach and health coaching for quality and regulatory needs.
• Arranges transportation and follow-up appointments for members.
• Documents actions taken and maintains confidentiality of PHI.
• Interacts with customer service to resolve member issues.
• Refer to case or disease management when appropriate.
• Completes special assignments essential to department functions.

Skills

Communication

Patient advocacy

HEDIS knowledge

Health coaching

Education

Bachelor's degree in Healthcare or related field

4 years total experience in healthcare/quality improvement

Job description

WellCare in Indianapolis is seeking a Patient Care Advocate to work with members and providers to close care gaps and improve the member and provider experience. You will educate practices on HEDIS measures and assist with scheduling and wraparound services during provider visits.

The role involves telephonic outreach and in-office education, collaborating with provider relations to enhance quality and regulatory compliance, and maintaining confidentiality of patient information while