730650 - Patient Care Advocate

Centene Corporation • Tallahassee, FL • 6h ago

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.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa @types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Hybrid based role, up 20% travel.

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.

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.

Pay Range: $27.02 - $48.55 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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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 applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Similar Jobs

RN/Flex Staff Nurse AC - Recovery

Tallahassee Memorial • Tallahassee, FL • 15h ago

Hospital & Medical Sponsored

Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 col...

15h ago

Go to Apply

RN/Flex Staff Nurse AC - Recovery

Tallahassee Memorial • Tallahassee, FL • 15h ago

Hospital & Medical Sponsored

15h ago

Go to Apply

Physical Therapist - ST

Amergis • Tallahassee, FL • 17h ago

Hospital & Medical

The Physical Therapist is responsible for performing patient evaluations, as well as providing and documenting therapy services in accordance with the plan of care developed for each individual patient and physician's or...

17h ago

Go to Apply

Physical Therapist - ST

Amergis • Tallahassee, FL • 17h ago

Hospital & Medical

17h ago

Go to Apply

Registered Nurse (RN) - ED Observation

Tallahassee Memorial • Tallahassee, FL • 1d ago

Hospital & Medical Sponsored

1d ago

Go to Apply

Registered Nurse (RN) Children's Emergency Department - No Experience Required

Tallahassee Memorial • Tallahassee, FL • 1d ago

Hospital & Medical Sponsored

1d ago

Go to Apply

Registered Nurse

UnitedHealth Group • Crawfordville, FL • 1d ago

Hospital & Medical

Explore opportunities with SunCrest OMNI, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helpin...

1d ago

Go to Apply

Health Information Specialist I - 5834

Datavant • Tallahassee, FL • 2d ago

Hospital & Medical

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is power...

2d ago

Go to Apply

Registered Nurse (RN) - Recovery

Tallahassee Memorial • Tallahassee, FL • 2d ago

Hospital & Medical Sponsored

2d ago

Go to Apply

Registered Nurse (RN) - Oncology Center Unit - $20k Sign-on Bonus & Relocation Assistance (if needed)

Tallahassee Memorial • Tallahassee, FL • 2d ago

Hospital & Medical Sponsored

2d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.