Patient Care Advocate

📋 Description

• • Centene Corporation is seeking a dedicated and compassionate Patient Care Advocate to join our mission of transforming the health of communities, one person at a time. This pivotal role is designed for individuals who are passionate about making a tangible difference in the lives of our 28 million members, ensuring they receive the care they need and overcome barriers to accessing healthcare services.
• • As a Patient Care Advocate, you will serve as a crucial liaison, acting as the "face of WellCare" within provider communities. Your primary responsibility will be to work directly with members and healthcare providers, fostering strong relationships and facilitating seamless care delivery. This involves actively engaging with providers and their office staff, embedding yourself within their practices to understand their workflows and identify opportunities for improvement.
• • A significant aspect of your role will be to close care gaps identified for members. This includes proactively identifying members who are due for preventive services or require follow-up care. You will be instrumental in educating members and their families about these care gaps, explaining the importance of recommended screenings and appointments, and empowering them to take control of their health.
• • You will play a key role in improving HEDIS (Healthcare Effectiveness Data and Information Set) measures. This involves advising and educating provider practices on appropriate HEDIS measures, as well as the correct ICD-10 and CPT coding in accordance with NCQA (National Committee for Quality Assurance) requirements. By assessing provider performance data, you will identify strategies to enhance their performance in quality improvement initiatives.
• • Your responsibilities extend to supporting the implementation of quality improvement interventions and conducting audits related to plan providers. You will assist in resolving deficiencies that impact the plan's compliance with State and Federal standards, ensuring adherence to regulatory and contractual requirements.
• • A core function of this role is conducting telephonic outreach and providing health coaching to members. This outreach is vital for supporting quality improvement efforts and meeting regulatory and contractual obligations. You will also conduct face-to-face education sessions with members and their families while they are in the provider's office, offering personalized guidance and support.
• • To ensure members can access the care they need, you will schedule doctor appointments on behalf of practitioners for members identified with care gaps. Furthermore, you will assist members with essential wraparound services, which may include arranging transportation to appointments and connecting them with valuable community-based resources and other available affinity programs.
• • Maintaining the confidentiality of all business and protected health information is paramount. You will meticulously document all actions taken in relation to member interactions, ensuring accurate and thorough record-keeping.
• • You will collaborate effectively with other internal departments, such as customer service, to resolve member issues efficiently. Additionally, you will refer members to case management or disease management programs when appropriate, ensuring they receive specialized support tailored to their health needs.
• • This role requires a proactive and adaptable individual who can complete special assignments and projects instrumental to the department's function, demonstrating a commitment to continuous improvement and operational excellence.
• • You will be expected to comply with all company policies and standards, upholding the highest levels of professionalism and ethical conduct in all aspects of your work.
• • This is a hybrid-based role, requiring up to 20% travel to provider offices and member locations within Florida. You must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.