Clinical - Patient Care Advocate

Position Title: Patient Care Advocate

Location: Lewes, DE 19958

Duration: 3 Months, with potential extension or conversion

Schedule: Mon-Fri 8 a.m. 5 p.m. EST No weekends or holidays No OT

PR: $28 to $32/hr.

Job Overview

• Improving HEDIS performance, strengthening provider partnerships, and enhancing the member experience by reducing barriers to care. We are targeting high-impact preventive and chronic care measures to drive measurable year-over-year improvement. This role is essential in turning strategy into action. By conducting outreach, closing care gaps in real time, and addressing member barriers like transportation, the individual directly drives quality outcomes, improves provider performance, and enhances trust with members and practices. We have a high volume of members with open care gaps who need targeted outreach to schedule appointments. These positions will fulfill that need. The team culture and work environment is a flexible, collaborative environment that will allow these candidates to work independently while also driving meaningful health outcomes for our members.

Key Responsibilities

• 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.

Minimum Qualifications

• 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)
• Preferred: RN, LPN, LMSW, LSW, Certified Social Worker

Years of experience required:

• 2 years. Work experience should be in direct patient care, social work, quality improvement, or health coaching preferably in a managed care environment.

Top 3 must-have hard skills stack-ranked by importance

• Excellent customer service skills
• Member and/or patient outreach and care gap closure (telephonic and/or in-person)
• Familiarity with Medicaid, Medicare Advantage, or dual populations