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Patient Care Advocate (LPN or SW Preferred)

Company: Wellcare Health Plans
Location: Lafayette
Posted on: November 10, 2019

Job Description:

WellCarehas an immediate opportunity for a Patient Care Advocate to join our Louisianateam!In this role you will work withmembers and providers to close care gaps, ensure barriers to care are removed,and improve the overall member and provider experience through outreach andface-to-face interaction with members and providers at large IPA and/or grouppractices.You will also serve tocollaborate with providers in the field, to improve HEDIS measures and provideseducation for HEDIS measures and coding.Our ideal candidate is someone with experience in healthcare orinsurance who has 2 years of experience in direct patient care, social work,quality improvement or health coaching preferably in a managed careenvironment.At WellCare, we empower youto manage the relationship and provide the resources to be successful. This position offers a robust benefitspackage including over 3 weeks of paid time off, 8 holidays and 2 floatingholidays and much more!Reports to: Sr., Manager, Quality ImprovementDepartment: Health ServicesLocation: Lafayette, LA 70506Essential 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 officeCandidate 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 skillsIntermediate Demonstrated written communication skillsIntermediate Ability to create, review and interpret treatment plansIntermediate Ability to effectively present information and respond to questions from families, members, and providersIntermediate Ability to multi-taskIntermediate Ability to work in a fast paced environment with changing prioritiesIntermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusionsIntermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial recordsIntermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusionsIntermediate Demonstrated organizational skillsIntermediate Ability to work independentlyIntermediate Knowledge of healthcare deliveryIntermediate 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 OutlookRequired Intermediate Microsoft Excel Ability to use and navigate health service management systemsRequired Intermediate Microsoft OutlookRequired Intermediate Healthcare Management Systems (Generic) Languages:Preferred SpanishAbout usHeadquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Keywords: Wellcare Health Plans, Lafayette , Patient Care Advocate (LPN or SW Preferred), Other , Lafayette, Louisiana

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