Member Care Advocate Manager

Turning everyday check-ins into better outcomes for the members who need it most. Wellth is a healthcare technology company that uses behavioral science and real-time engagement to help health plans improve medication adherence, close care gaps, and drive better outcomes for their highest-need members. Our platform combines a daily check-in app with a cue-routine-reward highlight engine and a human-in-the-loop Member Care Advocate (MCA) layer — creating a dual-channel system that reaches members where they are and escalates intelligently when they need more. Our platform combines a daily check-in app with a cue-routine-reward highlight engine and a human-in-the-loop Member Care Advocate (MCA) layer — creating a dual-channel system that reaches members where they are and escalates intelligently when they need more. As Wellth expands its quality improvement programs into HEDIS, Medicare Stars, and chronic condition management, the MCA function is evolving from a reactive support role into a proactive, data-driven care navigation capability. The MCA Manager will build and lead this next chapter. Build the engine that turns member data into better care -- while keeping your hands on the wheel. The Member Care Advocate Manager oversees the MCA team's day-to-day operations while building the analytical and programmatic infrastructure that turns raw member engagement data into targeted, timely care interventions. This is a player-coach role for our current stage: you will carry a small personal portfolio of complex member cases while simultaneously designing the systems, workflows, and team capabilities that will scale across a growing membership base. You will sit at the intersection of quality strategy, product operations, and front-line care — translating HEDIS measure logic, PDC-clock math, and Stars priority scoring into clear daily queues and coaching for your advocates. You will own the four-phase operational cycle — Data Aggregation, Risk Stratification, Trend Detection & Gap Analysis, and Intervention — and be accountable for the team's contribution to measure closure rates. Your work will be split into 4 main responsibilities: Data Aggregation & Member Intelligence Synthesize member data from the Wellth app highlight engine, Member Care Queues, supplemental data feeds (pharmacy, lab, claims), and partner health plan sources into a unified, advocate-ready view. Define and maintain the data standards and intake processes that ensure every member's current measure status, PDC calculation, and outreach history are current before advocates make contact. Partner with Product and Engineering to surface actionable signals through the Member Care Queue interface rather than requiring advocates to manually navigate raw data. Operate and refine Wellth's cohort segmentation model, assigning members to tiers ranging from digitally self-sufficient to advocate-forward based on engagement history, measure gaps, and clinical risk. Risk Stratification & Cohort Management Translate PDC-clock mathematics and HEDIS measure timelines into calendar-driven prioritization — ensuring advocates always work the highest-impact members first within each measurement year window. Own the priority scoring formula and escalation thresholds; adjust parameters in response to real-world close rates and changing plan priorities. Identify and flag members in advocate-forward measures (particularly FUM/FUH follow-up after behavioral health discharge and TRC transitions of care) where the MCA call is the entry point — not the fallback. Trend Detection & Gap Analysis Monitor aggregate performance across priority HEDIS measures detect cohort-level or geography-level anomalies before they become measure-year liabilities. Flag emerging clinical trends: low preventive screening rates in specific markets, rising rates of uncontrolled diabetes or medication adherence Collaborate with the Quality team to translate trend findings into program adjustments — new journey logic, revised outreach scripts, or escalation rule changes — and track whether interventions close the identified gaps. Surface insights to internal leadership and plan partners in a format that connects member-level activity to measure projections. Intervention & MCA Team Execution Lead the MCA team's daily execution against Member Care Queues — ensuring advocates reach the right member, through the right channel, with the right message, within each measure's action window. Enforce the one-outreach-per-7-day consolidation rule and manage exception protocols for members in acute transitions (post-discharge, recent diagnosis, medication change). Develop and maintain outreach scripts, decision trees, and escalation guides for each HEDIS measure journey, keeping them current with regulatory updates and real-world advocate feedback. Personally carry a caseload of complex or high-priority members — remaining connected to front-line complexity while modeling the standard for the team. From reactive support to proactive care navigation -- and you'll build the next chapter. Your responsibilities will include: Hire, onboard, and develop a team of Member Care Advocates, building a culture of accountability, clinical curiosity, and member-centered communication. Conduct regular one-on-ones, call reviews, and performance coaching; design scorecards that measure both activity (contacts, completions) and outcomes (measure closures, member re-engagement). Build career pathways for advocates interested in deeper clinical or analytical roles as the MCA function matures. Serve as the primary internal point of contact for cross-functional teams — Product, Engineering, Quality, and Client Success — on all matters related to MCA workflow, tooling, and capacity planning. You will collaborate with: Members of the Client Success team, Operations team, and external stakeholders You’ll report to: Our Vice President of Quality for strategic guidance, agile decision-making, and to support your career development and leadership growth. You might be the candidate we’re looking for. We’re looking for someone who has: 3+ years in case management, care coordination, digital health coaching or similar with at least 1–2 years in a lead or supervisory capacity. Working knowledge of HEDIS measures, comfort translating measure specifications into operational protocols. Experience managing or mentoring front-line care teams in a metrics-driven environment. Strong analytical instincts: able to read a member cohort dashboard, identify outliers, and translate the finding into a concrete team action. Excellent written and verbal communication — can write a clear outreach script and also present trend data to a health plan partner. Bonus points. These additional qualifications make you stand apart: Experience in a digital health or health tech company where you operated at the intersection of technology product and human care delivery. RN, LPN, LSW, or CHW credential, or equivalent clinical/community health background. Experience with care management platforms, CRM tools, or health plan quality reporting systems. You will enjoy working with us at Wellth. The benefits of working with us include: Flexible working arrangements, supporting strong remote-first practices and tools with the option to work in our excellent gathering space in Marina Del Rey. Robust paid time off and generous parental leave program. Competitive salary & equity structure. Health, dental, vision insurance, and FSA/HSA plans. Ability to have a positive impact on people who need it most. Support of a highly dedicated team focused on building the future of healthcare. Base Compensation: $80,000 - $95,000 Wellth is an equal opportunity employer. We value diversity at our company. We do not discriminate based on race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or other protected characteristics.