Patient Care Advocate

Centene Corporation; Lansing (MI); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work options (remote, hybrid,

field or office)

Job summary

Centene Corporation is seeking a full-time member outreach specialist to close care gaps and coordinate with providers in Michigan. The role involves education on HEDIS measures, scheduling preventive care, and addressing barriers to care in the provider offices.

You will work with providers and members to enhance access to preventive services, coordinate transport, and document all interactions while ensuring confidentiality of PHI.

Qualifications

• Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field.
• Total of 4 years of experience required for the position; 2+ years in direct patient care, social work, quality improvement or health coaching preferred in managed care.

Responsibilities

• Acts as liaison between member/family, physician and facilities/agencies.
• Faces the provider community as the face of Centene with office staff where services are embedded.
• Educates provider practices in HEDIS measures and coding per NCQA requirements.
• Assesses provider performance data to identify improvement opportunities.
• Collaborates with Provider Relations to improve provider performance in Quality, Risk Adjustment, and Operations.
• Schedules appointments for members with care gaps to access preventive care services.
• Conducts in-office and telephonic outreach and health coaching to support quality initiatives.
• Arranges transportation and follow-up appointments as needed.
• Documents all actions taken regarding member contact.

Skills

Member outreach

Provider collaboration

HEDIS knowledge

Education on preventive care

HIPAA/privacy

Education

Bachelor's degree in Healthcare or related field

Tools

EMR systems

NCQA guidelines

Job description

Business Area: Administrative & Claims Operations

Job Type: Full time

Position Purpose:

Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding. Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS. Conducts telephonic outreach, while embedded in the providers' offices, to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have when in the providers office for medical appointments. Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information.

Key Details: Must reside in the state of Michigan. Some travel required within and near Kalamazoo.

• 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.

Education/Experience:

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/Certification: 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.

Licenses/Certifications:

For Michigan plan only: Driver's license requiredPay Range: $27.02 - $48.55 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act