Patient Care Advocate

WellCare - Thomasville, GA

Department: ACO CM-Georgia

Reports to: ACO Market Manager

Location: Southwest, GA-remote w/travel

WellCare has an immediate opportunity for an experienced Patient Care Advocate to join our team! This is a remote position within Southwest Georgia to include Thomasville, Tifton and surrounding areas and requires over 75% travel. This position offers a robust benefits package including over 3 weeks of paid time off, 8 holidays and 2 floating holidays, mileage reimbursement and much more!

Some nuances about this role:
This role is home based in Georgia and requires travel in the field to our members’ homes, Skilled Nursing Facilities (SNF), Assisted Living Facilities (ALF) and rehabilitation centers (travel expenses will be reimbursed). Our Patient Care Advocates evaluate our members holistically and identify what the needs are and works in collaboration with the primary care physician, staff, care-givers and facility to meet the health needs of the member in all areas. Our ideal candidate is confident, empathetic, interpersonal and attentive to details; a problem solver and a persistent driver who has done in home assessments. NOTE: this is NOT a telephonic role. Our selected candidate will excel at educating members to fully utilize appropriate channels to get their needs met and have excellent time management skills in order to meet visitation target goals.

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.

Essential Functions:
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 for members as needed.
Arranges 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.

Additional Responsibilities:
Position may be located in a provider's office

Candidate Education:
Required A Bachelor's Degree in Healthcare, Public Health, Nursing, psychology, Social Work, Health Administration, or related health field or equivalent work experience (a total of 4 years of experience required for the position); Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.

Candidate Experience:
Required 2 years of experience in Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment

Candidate Skills:
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated written communication skills
Intermediate Ability to create, review and interpret treatment plans
Intermediate Ability to effectively present information and respond to questions from families, members, and providers
Intermediate Ability to multi-task
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
Intermediate Demonstrated organizational skills
Intermediate Ability to work independently
Intermediate Knowledge of healthcare delivery
Intermediate Other Appreciation and sensitivity towards cultural diversity and targeted populations

Licenses and Certifications:A license in one of the following is required:
Preferred Licensed Practical Nurse (LPN)
Preferred Licensed Master Social Work (LMSW)
Preferred Certified Social Worker (C-SW)
Preferred Licensed Social Worker (LSW)
Preferred Licensed Registered Nurse (RN)

Technical Skills:
Required Intermediate Microsoft Word Proficient in Microsoft Office such as Word, Excel and Outlook
Required Intermediate Microsoft Excel Ability to use and navigate health service management systems
Required Intermediate Microsoft Outlook
Required Intermediate Healthcare Management Systems (Generic)

Preferred Spanish