Patient Care Advocate - Remote role with travel reimbursement in Pennsylvania (Apply in minutes)
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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 competitivebenefits including a fresh perspective on workplace flexibility.**2 POSITIONS AVAILABLE. MUST RESIDE IN THE STATE OF PENNSYLVANIA, PITTSBURGH,THE WESTERN SIDE OF THE STATE.****THESE ROLES ARE WORK FROM HOMEREMOTE WITH 50 - 75% TRAVEL TO ASSIGNEDPROVIDER OFFICES AS NEEDED. MILEAGE WILL BE REIMBURSED AT THE CURRENT IRSGUIDELINE RATE ROUND TRIP FOR THIS TRAVEL.****WORK SCHEDULE WILL BE MONDAY - FRIDAY 8:30AM - 5:30PM; SCHEDULE MAY BEDIFFERENT DURING THE TRAINING TIME FRAME.****Position Purpose:** Works with members and providers to close care gaps,ensure barriers to care are removed, and improve the overall member andprovider experience through outreach and face-to-face interaction with membersand providers at large IPA andor group practices. Serves to collaborate withproviders in the field, to improve HEDIS measures and provides education forHEDIS measures and coding. Supports the implementation of quality improvementinterventions and audits in relation to plan providers. Assists in resolvingdeficiencies impacting plan compliance to meeting State and Federal standardsfor HEDIS. Conducts telephonic outreach, while embedded in the providersoffices, to members who are identified as needing preventive services insupport of quality initiatives and regulatorycontractual requirements.Provides education to members regarding the care gaps they have when in theproviders office for medical appointments. Schedules doctor appointments onbehalf of the practitioner and assists member with wraparound services such asarranging transportation, connecting them with community-based resources andother affinity programs as available. Maintains confidentiality of businessand protected health information.* Acts as a liaison and member advocate between the memberfamily, physician and facilitiesagencies.* 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**EducationExperience:****Required:** a Bachelors Degree in Healthcare, Public Health, Nursing,Psychology, Social Work, Health Administration, or related health field orequivalent work experience required (a total of 4 years of experience requiredfor the position); work experience should be in direct patient care, socialwork, quality improvement or health coaching preferably in a managed careenvironment. 2+ years of experience work experience should be in directpatient care, social work, quality improvement or health coaching preferablyin a managed care environment.**LicenseCertification:** One of the following is preferred. LicensedPractical Nurse (LPN); Licensed Master Social Work (LMSW); Certified SocialWorker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN)preferred.Pay Range: $25.97 - $46.68 per hourCentene offers a comprehensive benefits package including: competitive pay,health insurance, 401K and stock purchase plans, tuition reimbursement, paidtime off plus holidays, and a flexible approach to work with remote, hybrid,field or office work schedules. Actual pay will be adjusted based on anindividuals skills, experience, education, and other job-related factorspermitted by law. Total compensation may also include additional forms ofincentives.Centene is an equal opportunity employer that is committed to diversity, andvalues the ways in which we are different. All qualified applicants willreceive consideration for employment without regard to race, color, religion,sex, sexual orientation, gender identity, national origin, disability, veteranstatus, or other characteristic protected by applicable law.Qualified applicants with arrest or conviction records will be considered inaccordance with the LA County Ordinance and the California Fair Chance Act