Patient Care Advocate LPN, LMSW

Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. Centene offers affordable and high-quality products to more than 1 in 15 individuals across the nation, including Medicaid and Medicare members (including Medicare Prescription Drug Plans) as well as individuals and families served by the Health Insurance Marketplace. Centene believes healthcare is best delivered locally. Our local health plans provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene’s hiring practices reflect the composition of the members and communities we serve, allowing us to deliver quality, culturally sensitive healthcare to millions of members. Centene employees help change the world of healthcare and transform our communities. To learn more about career opportunities with Centene, visit: https://jobs.centene.com/

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 competitive benefits including a fresh perspective on workplace flexibility. This is a hybrid position with about 25% local travel to provider offices in Kent, Muskegon, or Calhoun counties, MI. When not traveling, the role is remote. Ideal candidate will have an LPN or social work license. 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. Serves to collaborate 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.

Acts as a liaison and member advocate between the member/family, physician and facilities/agencies. 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