Patient Care Advocate

BCforward; Elkhart (IN); On-site; USD 39,000 - 55,000; Full time

Job summary

BCforward is seeking a healthcare liaison to serve at WellCare-affiliated clinics in Indiana. The role educates providers on HEDIS measures and coding, coordinates care gaps, and supports quality improvement efforts in a managed care setting.

The position requires a bachelor's in a health field and 4 years of related experience, with 2+ years in direct patient care. Onsite work at designated health centers in Elkhart/Indianapolis, with a 3-month contract and potential extension.

Qualifications

• Bachelor’s degree in healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related field.
• 4 years of experience in direct patient care, social work, quality improvement or health coaching.
• 2+ years in direct patient care within a managed care environment preferred.

Responsibilities

• Acts as a liaison between member/family, physician and facilities.
• Represents WellCare in the provider community with office staff.
• Educates Provider practices in HEDIS measures and HEDIS ICD-10/CPT coding per NCQA.
• Analyzes provider performance data to identify improvement opportunities.
• Works with Provider Relations to improve quality, risk adjustment and operations.
• Schedules appointments for care gaps and coordinates preventive services.
• Delivers in-person and telephonic education to members and families.
• Arranges transportation and follows up on care needs; documents actions.
• Collaborates with other departments to resolve issues and complete special projects.

Skills

Communication

Health coaching

Provider relations

Patient advocacy

Education

Bachelor’s degree in healthcare or related field

Job description

Duration: 03 Months (Possible Extension or Conversion)

Work Type: Onsite to the locations noted in the requests: HM will follow up once physical location addresses are confirmed.

Shift: Mon-Fri, 8a-5p Depends on clinic assigned so may be either EST or CST

Pay Rate: $34.07/hr

Locations:

• Heart City Health (FQHC) – Scenic Health Center, 148 W. Hively Avenue, Suite 1, Elkhart, IN 46517
• Jane Pauley Community Health Center (FQHC), 1315 N. Arlington Avenue, Indianapolis, IN 46219

Duties:

Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.

Acts as the face of WellCare in the provider community with the provider and office staff where their services are embedded.

Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.

Assesses provider performance data to identify and strategizes opportunities for provider improvement.

Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).

Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office.

Conducts face-to-face education with the member and their family, in the provider’s office, about care gaps identified, and barriers to care.

Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.

Arranges transportation and follow-up appointments for member as needed. Documents all actions taken regarding contact related to member. Interacts with other departments including customer service to resolve member issues. Refers to case or disease management as appropriate. Completes special assignments and projects instrumental to the function of the department. Performs other duties as assigned Complies with all policies and standards.

Required: a bachelor’s degree in healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position); work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment. 2+ years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.

License:

Required: One of the following is preferred. Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.

Years of experience required: Working in ambulatory/outpatient practice; HEDIS Review (Chart Abstraction/Measures)

Top Skills:

• Basic understanding of how outpatient works (FQHC)