Patient Care Advocate at Centene

Ideal for an LPN, RN, or licensed social worker with at least two years of experience in direct patient care, managed care, or quality improvement. You must hol

Work type: remote

Location: Remote-MI | Muskegon-Michigan(49442)

Salary: $27 – $49/hr

Type: Full-time

Summary

Ideal for an LPN, RN, or licensed social worker with at least two years of experience in direct patient care, managed care, or quality improvement. You must hold a relevant healthcare license or a bachelor’s degree in a health-related field with four years of equivalent professional experience. **What makes it worth a look...** Centene pays between $27.02 and $48.55 per hour for this role. While primarily remote, it is a hybrid position that requires about 25% travel to provider offices across Kent, Muskegon, or Calhoun counties in Michigan. **You might be a good fit if you...** * Have experience improving HEDIS measures and navigating ICD-10 or CPT coding. * Can comfortably conduct face-to-face health education and outreach in provider offices. * Know how to collaborate with medical practices to resolve care gaps and compliance deficiencies. * Are skilled at managing provider performance data to drive quality improvement interventions.

Job Description

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 is a hybrid position with about 25% local travel to provider offices in Kent, Muskegon, or Calhoun counties, MI. When not traveling, the role is remote. Ideal candidate will have an LPN or social work license.

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.

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