What are the responsibilities and job description for the Patient Care Advocate position at Actalent?
Job Description:
- 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
Education/Experience:
- Required A 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.
- 2 years of experience work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment,
License/Certification:
- 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) preferred
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
Actalent is an equal opportunity employer.
About Actalent
Actalent connects passion with purpose. We help visionary companies advance their engineering and science initiatives through access to specialized experts that drive scale, innovation, and speed to market. With a network of almost 30,000 engineering and sciences consultants and more than 4,500 clients across the U.S., Canada, Asia, and Europe, Actalent serves many of the Fortune 500. An operating company of Allegis Group, the global leader in talent solutions, Actalent launched as a new specialized engineering and sciences services and workforce solutions brand in 2021.
Salary : $24 - $29
