Immediate need for a talented Patient Care Advocate . This is a 03 Months Contract opportunity with long-term potential and is located in KY(Remote) .

Please review the job description below and contact me ASAP if you are interested.

Job ID : 24-20647

Pay Range : $28 - $30 / hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Note- Candidate must reside in KY.

NOTE : This contractor with be WFH supporting member outreach work.

Key Responsibilities :

• These team members will be making outreach calls to members to educate regarding plan benefits and care gaps, assisting with warm transfers to provider offices to schedule appointments as needed, and assisting members in other ways that are beneficial to the member.
• Working with providers scheduling member appointments, collecting medical records, and abstracting medical records. Specified performance metrics to be determined.
• They may assist with medical record collection efforts and HEDIS measure abstraction.
• 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.
• 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.
• 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.

Key Requirements and Technology Experience :

• Proficient Microsoft Word, Excel, Outlook, Teams, Kofax or PDF.
• Great communication &-Customer Service skillset / Professional demeaner.
• Medical record collection experience.
• Bachelor’s degree in healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required.

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.
• One of the following is preferred : Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW);

Licensed Social Worker (LSW); Licensed Registered Nurse (RN).

• Ideal background / job titles :
• Community health workers, care managers, care coordinators, transition of care coordinators.
• Clinical administrative background.
• Working with providers focusing on the quality on the provider end.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions.

If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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Last updated : 2024-05-02