Patient Care Advocate

Jobtailor; Little Rock (AR); On-site; USD 55,000 - 75,000; Full time

Job summary

Jobtailor in the United States is seeking a healthcare quality improvement professional to close care gaps by coordinating with members and providers. You will educate providers on HEDIS and coding requirements, support audits, and drive QI initiatives to improve NCQA compliance.

You will lead outreach and health coaching, schedule appointments, and connect members with community resources while acting as a liaison among members, providers, and agencies.

Qualifications

• Authorized to work in the U.S. without visa sponsorship.
• Must locate near Little Rock, Arkansas.
• Driver's license required.
• Travel may be required.
• Bachelor's degree or equivalent work experience in a health field.
• 4 years of experience required for the position.
• 2+ years in direct patient care, social work, quality improvement or health coaching.

Responsibilities

• Close care gaps with members and providers and remove barriers to care.
• Improve member/provider experience through outreach and face-to-face interaction.
• Collaborate with providers to improve HEDIS measures.
• Educate providers on HEDIS, ICD-10/CPT coding per NCQA.
• Support quality improvement interventions and audits for plan providers.
• Resolve deficiencies affecting compliance with state and federal standards.
• Conduct telephonic outreach and health coaching for preventive services.
• Provide face-to-face education to members and families about care gaps.
• Schedule doctor and follow-up appointments; arrange transportation and connect to community resources.
• Act as liaison between members, physicians, facilities, and agencies; represent in provider community.
• Assess provider performance data and identify improvement opportunities.

Skills

HEDIS Measures

ICD-10 Coding

CPT Coding

Quality Improvement

Health Coaching

Patient Advocacy

Compliance Resolution

Data Assessment

Telephonic Outreach

Documentation

Education

Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field, or equivalent work experience

Licensed Practical Nurse (LPN)

Licensed Master Social Work (LMSW)

Certified Social Worker (C-SW)

Licensed Social Worker (LSW)

Licensed Registered Nurse (RN)

Job description

• Work with members and providers to close care gaps and remove barriers to care
• Improve member and provider experience through outreach and face-to-face interaction
• Collaborate with providers in the field to improve HEDIS measures
• Educate providers on HEDIS measures and ICD-10/CPT coding in accordance with NCQA requirements
• Support quality improvement interventions and audits related to plan providers
• Resolve deficiencies affecting compliance with State and Federal HEDIS standards
• Conduct telephonic outreach and health coaching to members identified as needing preventive services
• Provide face-to-face education to members and families about care gaps and barriers to care
• Schedule doctor appointments and follow-up appointments for members
• Arrange transportation and connect members with community-based resources and affinity programs
• Act as liaison and member advocate between members/families, physicians, facilities, and agencies
• Serve as Centene/WellCare representative in the provider community
• Assess provider performance data and identify opportunities for improvement
• Collaborate with Provider Relations on Quality, Risk Adjustment, Operations, claims, and encounters
• Document all member contacts and actions taken
• Resolve member issues with other departments, including customer service
• Refer members to case or disease management as appropriate
• Complete special assignments and other duties as assigned
• Maintain confidentiality of business and protected health information
• Comply with all policies and standards

Requirements

• Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future
• Must be located near Little Rock, Arkansas
• Driver's license required
• Position may require travel
• Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field, or equivalent work experience
• A total of 4 years of experience required for the position when using equivalent work experience
• 2+ years of work experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment
• Preferred certifications/licenses: Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN)

Core Competencies

Demonstrates expertise in HEDIS measures, ICD-10/CPT coding, and quality improvement interventions while effectively collaborating with providers and advocating for members. Proficient in conducting outreach, health coaching, and resolving compliance issues within healthcare settings.

Highest-signal resume keywords

• HEDIS Measures
• ICD-10/CPT Coding
• Quality Improvement
• Health Coaching
• Direct Patient Care

ATS Optimization Keywords

Hard Skills

• Quality Improvement
• Health Coaching
• ICD-10 Coding
• CPT Coding
• HEDIS Measures
• Patient Advocacy
• Compliance Resolution
• Data Assessment
• Telephonic Outreach
• Documentation

Soft Skills

• Collaboration
• Communication
• Problem-Solving
• Interpersonal Skills
• Member Engagement

Certifications & Qualifications

• Licensed Practical Nurse (LPN)
• Licensed Master Social Work (LMSW)
• Certified Social Worker (C-SW)
• Licensed Social Worker (LSW)
• Licensed Registered Nurse (RN)

Industry Keywords

• Managed Care
• Preventive Services
• Community-Based Resources
• NCQA Requirements
• State and Federal Standards