Patient Care Advocate LPN, LMSW
PA Health & Wellness, Muskegon, MI, United States
You could change the health of our 28 million members. Centene transforms communities and offers competitive benefits, workplace flexibility, and a supportive environment.
This is a hybrid role, with about 25 % local travel to provider offices in Kent, Muskegon, or Calhoun counties, MI, and remote work otherwise. Ideal candidates hold an LPN or social work license.
Position Purpose
The role works with members and providers to close care gaps, remove barriers to care, and improve overall member and provider experience through outreach and face‑to‑face interaction at large IPA and/or group practices. The position collaborates with providers, improves HEDIS measures, provides education, supports quality improvement interventions, and conducts audits related to plan providers. Responsibilities include:
Acting as a liaison and member advocate between the member/family, physician, and facilities/agencies.
Serving as the face of WellCare in the provider community and office staff.
Advising and educating provider practices on appropriate HEDIS measures and HEDIS ICD‑10/CPT coding in accordance with NCQA requirements.
Assessing provider performance data to identify opportunities for improvement.
Collaborating with Provider Relations to improve provider performance in Quality, Risk Adjustment, and Operations.
Scheduling doctor appointments for members with care gaps.
Conducting face‑to‑face education with members and families about identified care gaps and barriers.
Performing telephonic outreach and health coaching to support quality improvement, regulatory, and contractual requirements.
Arranging transportation and follow‑up appointments as needed.
Documenting all actions related to member contact.
Interacting with other departments, including customer service, to resolve member issues.
Referring to case or disease management when appropriate.
Completing special assignments and projects instrumental to the department’s function.
Performing other duties as assigned.
Complying with all policies and standards.
Education & Experience
Required: A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related field, or equivalent work experience. A total of 4 years of experience is required, with at least 2 years in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.
License / Certification
Preferred: Licensed Practical Nurse (LPN); Licensed Master Social Worker (LMSW); Certified Social Worker (C‑SW); Licensed Social Worker (LSW); or Licensed Registered Nurse (RN).
Pay Range
$27.02 – $48.55 per hour. Pay will be adjusted based on skills, experience, education, and other job‑related factors, including full‑time or part‑time status.
Benefits
Comprehensive benefits package, including competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements.
EEO & Equal Opportunity Employer
Centene is an equal‑opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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This is a hybrid role, with about 25 % local travel to provider offices in Kent, Muskegon, or Calhoun counties, MI, and remote work otherwise. Ideal candidates hold an LPN or social work license.
Position Purpose
The role works with members and providers to close care gaps, remove barriers to care, and improve overall member and provider experience through outreach and face‑to‑face interaction at large IPA and/or group practices. The position collaborates with providers, improves HEDIS measures, provides education, supports quality improvement interventions, and conducts audits related to plan providers. Responsibilities include:
Acting as a liaison and member advocate between the member/family, physician, and facilities/agencies.
Serving as the face of WellCare in the provider community and office staff.
Advising and educating provider practices on appropriate HEDIS measures and HEDIS ICD‑10/CPT coding in accordance with NCQA requirements.
Assessing provider performance data to identify opportunities for improvement.
Collaborating with Provider Relations to improve provider performance in Quality, Risk Adjustment, and Operations.
Scheduling doctor appointments for members with care gaps.
Conducting face‑to‑face education with members and families about identified care gaps and barriers.
Performing telephonic outreach and health coaching to support quality improvement, regulatory, and contractual requirements.
Arranging transportation and follow‑up appointments as needed.
Documenting all actions related to member contact.
Interacting with other departments, including customer service, to resolve member issues.
Referring to case or disease management when appropriate.
Completing special assignments and projects instrumental to the department’s function.
Performing other duties as assigned.
Complying with all policies and standards.
Education & Experience
Required: A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or a related field, or equivalent work experience. A total of 4 years of experience is required, with at least 2 years in direct patient care, social work, quality improvement, or health coaching, preferably in a managed care environment.
License / Certification
Preferred: Licensed Practical Nurse (LPN); Licensed Master Social Worker (LMSW); Certified Social Worker (C‑SW); Licensed Social Worker (LSW); or Licensed Registered Nurse (RN).
Pay Range
$27.02 – $48.55 per hour. Pay will be adjusted based on skills, experience, education, and other job‑related factors, including full‑time or part‑time status.
Benefits
Comprehensive benefits package, including competitive pay, health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, holidays, and flexible work arrangements.
EEO & Equal Opportunity Employer
Centene is an equal‑opportunity employer committed to diversity. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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