You may also apply directly at: http://floridainterviews.com/job/patient-care-advocate-job-with-wellcare-health-plans/

The position listed below is not with Florida Interviews but with WellCare Health Plans

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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)
              Languages:
              • Preferred Spanish
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