Patient Care Advocate - Onsite - HEDIS experience needed

Job Description

Job Description

Position Description:

The Patient Care Advocate serves as a key liaison between health plan members, healthcare providers, and community partners to improve member health outcomes and quality performance. This field-based role is embedded within Federally Qualified Health Centers (FQHCs) and provider practices, where the advocate works directly with members and clinic staff to identify and close gaps in care, coordinate preventive services, and support quality improvement initiatives.

The ideal candidate is experienced in patient outreach, care coordination, population health, social services, health coaching, or quality improvement and possesses a strong understanding of outpatient healthcare operations and HEDIS-related activities.

Key Responsibilities

· Serve as a trusted advocate and liaison between members, families, healthcare providers, and community resources.

· Conduct telephonic and face-to-face outreach to engage members and address identified care gaps.

· Schedule preventive care appointments and coordinate follow-up services to improve healthcare compliance.

· Educate members and families regarding preventive healthcare, treatment plans, and available community resources.

· Partner with provider offices and clinical teams to improve quality metrics and patient outcomes.

· Support HEDIS and NCQA quality initiatives through member engagement, chart review support, and provider collaboration.

· Assess provider performance data and identify opportunities for quality improvement.

· Collaborate with Provider Relations, Care Management, Quality, Customer Service, and Operations teams to resolve member issues and improve service delivery.

· Arrange transportation and other support services to ensure member access to care.

· Maintain accurate and timely documentation of all member interactions and outreach efforts.

· Refer members to Case Management, Disease Management, Behavioral Health, or other appropriate programs as needed.

· Participate in special projects and departmental initiatives supporting organizational objectives.

· Adhere to all Centene, MHS, regulatory, and compliance standards.

Required Qualifications

Education

· Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related field; OR

· Equivalent combination of education and experience totaling at least four years.

Experience

· Minimum 2+ years of experience in one or more of the following:

o Direct patient care

o Care coordination

o Social work

o Health coaching

o Population health

o Managed care

o Quality improvement

Required Knowledge & Skills

· Experience working in an ambulatory or outpatient healthcare setting.

· Experience supporting HEDIS reviews, chart abstraction, care gap closure, or quality initiatives.

· Strong communication, patient engagement, and relationship-building skills.

· Ability to work independently in a field-based environment.

· Strong organizational and time management abilities.

· Proficiency with Microsoft Office and electronic healthcare systems.