Patient Care Advocate

Spectraforce Technologies, Inc.; Lewes (DE); On-site; USD 28,000 - 39,000; Full time

Job summary

Spectraforce Technologies, Inc. is hiring a Patient Care Advocate in Lewes, DE. The role supports health plan initiatives to close care gaps, improve HEDIS performance, and strengthen provider partnerships through targeted outreach and member education. Typical hours are Mon-Fri, 8 a.m.

to 5 p.m. EST, with field work in Lewes and nearby areas. The position emphasizes liaison work among members, families, physicians, and facilities, and requires a Bachelor’s degree in a health field and 2+ years

Qualifications

• Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related field or equivalent work experience (4 years total)
• Strong communication and interpersonal skills for member outreach and education
• Familiarity with Medicaid/Medicare programs and quality improvement concepts

Responsibilities

• Act as liaison and advocate between members, families, providers, and facilities
• Educate and advise provider practices on HEDIS measures and coding requirements
• Identify opportunities to improve provider performance using member data
• Schedule appointments and arrange transportation to close care gaps
• Conduct face-to-face and telephonic outreach and health coaching
• Document all member contacts and follow-up actions
• Collaborate with other departments to resolve member issues
• Participate in special projects that support department goals

Skills

Customer service

Outreach to members

MS Medicaid/Medicare familiarity

Education

Bachelor's degree in healthcare/related field

Job description

Title: Patient Care Advocate

Duration: 3 Months - Possible extension or conversion

Location: 34382 Carpenters Way Lewes, DE 19958

Note: Source from Lewes and nearby area; Field work within Lewes and nearby areas

Mon-Fri | 8 a.m. - 5 p.m. EST

No weekends or holidays | No OT

Position Purpose:

• Our team is focused on three core initiatives: improving HEDIS performance, strengthening provider partnerships, and enhancing the member experience by reducing barriers to care. We are targeting high-impact preventive and chronic care measures to drive measurable year-over-year improvement. This role is essential in turning strategy into action. By conducting outreach, closing care gaps in real time, and addressing member barriers like transportation, the individual directly drives quality outcomes, improves provider performance, and enhances trust with members and practices.
• HealthPlan has a high volume of members with open care gaps who need targeted outreach to schedule appointments. These positions will fulfill that need.

The team culture and work environment is a flexible, collaborative environment that will allow these candidates to work independently while also driving meaningful health outcomes for our members.

• 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.

Candidate Requirements

Education/Certification

Required: 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)

Preferred:

Licensure

Required: NA

Preferred: RN, LPN, LMSW, LSW, Certified Social Worker

Years of experience required: 2 years. Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.

Disqualifiers:

Additional qualities to look for:

Top 3 must-have hard skills stack-ranked by importance

1. Excellent customer service skills
2. Member and/or patient outreach and care gap closure (telephonic and/or in-person)
3. Familiarity with Medicaid, Medicare Advantage, or dual populations