Patient Care Advocate

4 weeks ago

Oklahoma City, Oklahoma, United States Centene Corporation Full time

You could be the one who transforms the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits, including a fresh perspective on workplace flexibility.

Position Purpose: Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices.

Key Responsibilities:

  • Collaborates with providers in the field to improve HEDIS measures and provides education for HEDIS measures and coding.
  • Supports the implementation of quality improvement interventions and audits in relation to plan providers.
  • Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS.
  • Conducts telephonic outreach, while embedded in the providers' offices, to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements.
  • Provides education to members regarding the care gaps they have when in the providers office for medical appointments.
  • Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available.
  • Maintains confidentiality of business and protected health information.

Requirements:

  • Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
  • Acts as the face of Centene 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 providers office.
  • Conducts face-to-face education with the member and their family, in the providers 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.

Preferred Qualifications:

  • Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.

Pay Range: $46.68 per hour

Benefits: Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.

Equal Opportunity Employer: Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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