Patient Care Advocate

🔥 17 hours ago

🐎 Kentucky, Mississippi, +2 more states – Remote

🐎 Kentucky – Remote 🎸 Mississippi – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

💵 $27 - $48 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Work with members and providers to close care gaps, remove barriers to care, and improve member and provider experience • Conduct outreach and face-to-face interaction with members and providers at large IPA and/or group practices • Collaborate with providers in the field to improve HEDIS measures • Provide education on HEDIS measures and coding • Support quality improvement interventions and audits related to plan providers • Assist in resolving deficiencies affecting plan compliance with State and Federal HEDIS standards • Conduct telephonic outreach while embedded in provider offices • Educate members about identified care gaps during medical appointments • Schedule doctor appointments on behalf of practitioners and members • Arrange transportation and connect members with community-based resources and affinity programs • Maintain confidentiality of business and protected health information • Act as liaison and member advocate between members/families, physicians, and facilities/agencies • Represent WellCare in the provider community • Advise and educate provider practices on HEDIS measures and HEDIS ICD-10/CPT coding in accordance with NCQA requirements • Assess provider performance data and identify opportunities for improvement • Collaborate with Provider Relations on Quality, Risk Adjustment, Operations, claims, and encounters • Conduct face-to-face member and family education regarding care gaps and barriers to care • Conduct telephonic outreach and health coaching • Arrange transportation and follow-up appointments • Document all member contact actions • Interact with departments including customer service to resolve member issues • Refer members to case or disease management as appropriate • Complete special assignments and projects • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • 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 • 2+ years of work experience in direct patient care, social work, quality improvement or health coaching, preferably in a managed care environment • Experience should be in direct patient care, social work, quality improvement or health coaching • Preferred license/certification: Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN)

🏖️ Benefits

• health insurance • 401K • stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules • additional forms of incentives may be included in total compensation