Patient Care Advocate

Work with members and providers to close care gaps and remove barriers to care Improve member and provider experience through outreach and face-to-face interaction Collaborate with providers in the field to improve HEDIS measures Educate providers on HEDIS measures and ICD-10/CPT coding in accordance with NCQA requirements Support quality improvement interventions and audits related to plan providers Resolve deficiencies affecting compliance with State and Federal HEDIS standards Conduct telephonic outreach and health coaching to members identified as needing preventive services Provide face-to-face education to members and families about care gaps and barriers to care Schedule doctor appointments and follow-up appointments for members Arrange transportation and connect members with community-based resources and affinity programs Act as liaison and member advocate between members/families, physicians, facilities, and agencies Serve as Centene/WellCare representative in the provider community Assess provider performance data and identify opportunities for improvement Collaborate with Provider Relations on Quality, Risk Adjustment, Operations, claims, and encounters Document all member contacts and actions taken Resolve member issues with other departments, including customer service Refer members to case or disease management as appropriate Complete special assignments and other duties as assigned Maintain confidentiality of business and protected health information Comply with all policies and standards Requirements Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future Must be located near Little Rock, Arkansas Driver's license required Position may require travel 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 when using equivalent work experience 2+ years of work experience in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment Preferred certifications/licenses: Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Certified Social Worker (C-SW), Licensed Social Worker (LSW), or Licensed Registered Nurse (RN) Core Competencies Demonstrates expertise in HEDIS measures, ICD-10/CPT coding, and quality improvement interventions while effectively collaborating with providers and advocating for members. Proficient in conducting outreach, health coaching, and resolving compliance issues within healthcare settings. Highest-signal resume keywords HEDIS Measures ICD-10/CPT Coding Quality Improvement Health Coaching Direct Patient Care ATS Optimization Keywords Hard Skills Quality Improvement Health Coaching ICD-10 Coding CPT Coding HEDIS Measures Patient Advocacy Compliance Resolution Data Assessment Telephonic Outreach Documentation Soft Skills Collaboration Communication Problem-Solving Interpersonal Skills Member Engagement Certifications & Qualifications Licensed Practical Nurse (LPN) Licensed Master Social Work (LMSW) Certified Social Worker (C-SW) Licensed Social Worker (LSW) Licensed Registered Nurse (RN) Industry Keywords Managed Care Preventive Services Community-Based Resources NCQA Requirements State and Federal Standards #J-18808-Ljbffr Jobtailor