Patient Care Advocate

Centene Corporation; Pennsylvania; Remote; USD 10,000 - 60,000; Full time

Job summary

A leading healthcare organization seeks a professional to advocate for members and improve care through outreach and education. The role involves collaborating with providers to enhance quality measures and assist members in accessing preventive services. Candidates should have a Bachelor's degree in a health-related field and experience in direct patient care or health coaching.

Benefits

Health Insurance

401K

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 4 years of experience in healthcare, ideally in managed care.
• 2 years of direct patient care or health coaching experience.

Responsibilities

• Work with members to close care gaps and improve experiences.
• Conduct telephonic outreach and health coaching.
• Educate members about care gaps and arrange services.

Skills

Patient Care

Quality Improvement

Health Coaching

Social Work

Education

Bachelor's Degree in Healthcare or related field

Job description

2 weeks ago Be among the first 25 applicants

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

THIS POSITION IS REMOTE IN THE STATE OF PENNSYLVANIA WITH 25% TRAVEL TO VISIT PROVIDER OFFICES. MILEAGE IS REIMBURSED AT THE CURRENT IRS GUIDELINE RATE ROUND TRIP.

PREFER A NURSE WHO RESIDES IN THE ALLENTOWN, SCRANTON, WILKES-BARRE, PA AREA.

THE WORK SCHEDULE IS MONDAY - FRIDAY 8:30 AM - 5 OR 5:30 PM; TRAINING HOURS MAY BE SLIGHTLY DIFFERENT.

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 members with wraparound services such as arranging transportation, connecting them with community-based resources and other programs as available. Maintains confidentiality of business and protected health information.

• 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 strategize 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 members 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). Work experience should be in direct patient care, social work, quality improvement or health coaching, preferably in a managed care environment. At least 2 years of 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.

Pay Range: $26.50 - $47.59 per hour

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. Total compensation may also include additional incentives.

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 law.