What are the responsibilities and job description for the Patient Care Advocate - HEDIS position at Actalent?
Job Title: Patient Care Advocate
Opportunity Summary:
- 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.
Skills
Patient outreach, Health education, Manage care, Clinical, HEDIS, Quality Improvement, Bachelor's degree, Managed Care experience, Medicare managed care
Top Skills Details
Patient outreach,Health education,Manage care,Clinical,HEDIS,Quality Improvement,Bachelor's degree
Qualifications
-Bachelor's degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or 4 years of equivalent work experience required.
- Clinical experience, HEDIS, and quality improvement
- 2 years of experience in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment
- License/Certification preferred but not required: Licensed Practical Nurse (LPN); Licensed Master Social Work (LMSW); Certified Social Worker (C-SW); Licensed Social Worker (LSW); Licensed Registered Nurse (RN) preferred.
- Telephonic experience is preferre
Reason for Open Position:
Supporting a new Quality Medicare Project
Must reside in Eastern time zone and needs to live in Richmond, Columbia, Fulton, Dekalb, Gwinnett, Cobb or Henry Counties Georgia.
Experience Level
Expert Level
Pay and Benefits
The pay range for this position is $21.00 - $26.00/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a fully remote position.
Application Deadline
This position is anticipated to close on Mar 15, 2025.
About Actalent
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & Inclusion
At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
Salary : $21 - $26
