Patient Care Advocate

Centene; United States; Remote; USD 37,000 - 67,000; Full time

Job summary

Centene seeks a field-based care coordination professional to work with members and providers, close care gaps, and improve experience. The role emphasizes education on HEDIS measures, coding, and regulatory compliance within large IPA or group practices.

The position includes telephonic and face-to-face outreach, appointment scheduling, transportation coordination, and support across care teams. Remote work is available for Iowa residents; nursing or social work credentials are advantageous.

Qualifications

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

Responsibilities

• Close care gaps by outreach and field collaboration with members and providers.
• Educate providers on HEDIS measures and ICD-10/CPT coding per NCQA requirements.
• Coordinate care with care teams, arrange transportation and wraparound services.
• Schedule and assist with preventive care appointments and follow-ups in the provider office.
• Maintain confidentiality of PHI and comply with policies and standards.

Skills

Direct patient care

Social work

Quality improvement

Health coaching

Education

Bachelor's degree in Healthcare/Related field

Job description

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

Remote opportunity for Iowa residents. Seeking 2+ years of experience in direct patient care, social work, quality improvement, or health coaching, with the required degree or equivalent experience. The PCA plays a key role in closing care gaps, connecting members to needed services, and coordinating across care teams to improve continuity of care and the member experience.

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 required

Pay Range

$27.02 - $48.55 per hour

About the Company

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.

Benefits

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