Care Advocate

• Conduct outreach to members in the community to identify care gaps and connect them with appropriate healthcare services and resources
• Perform home visits or community-based assessments to evaluate member needs and identify social determinants of health
• Facilitate care coordination and help members access preventive or follow-up care
• Help members navigate healthcare and social service systems
• Assist with appointment scheduling, care-plan understanding, and access to benefits or entitlements
• Collaborate with providers using quality performance data such as HEDIS and CAHPS
• Educate members on preventive care, chronic condition management, and community resources
• Document member interactions, care gap closures, and referrals in appropriate systems
• Partner with Quality, Care Management, and Provider Relations departments
• Monitor and report outreach effectiveness and care-gap closure metrics
• Maintain compliance with state and federal regulations and organizational policies
• Participate in seasonal campaigns and quality initiatives
• Build relationships with local organizations and stakeholders as a community ambassador
• Perform other duties as assigned and comply with all policies and standards

Quality care advocate improving Centene members’ health outcomes through community-based clinical support

Quality Care Advocate – Clinical

Quality care advocate helping Centene members close care gaps through outreach, home visits, education, and care coordination. Supporting healthier communities through improved access to preventive and chronic-care services.

• Prioritize tasks and manage a schedule of high-volume introductory video appointments with members
• Promptly answer member questions, assist with product-related needs, and provide personalized recommendations
• Deliver an exceptional member experience and appropriately escalate concerns or questions
• Navigate members’ healthcare networks to ensure access to care and investigate available resources and support
• Coordinate with team members to facilitate timely access to care, provide follow-up, and close the loop with members
• Provide education and resources related to members’ program needs
• Collaborate with cross-functional partners across Care Delivery, Customer Support, Provider, and Product teams
• Execute tasks supporting an optimal member experience and take ownership of outstanding items
• Participate in cross-functional projects and collaborate with other departments
• Identify referral needs and collaborate with Maven providers
• Anticipate and address members’ social determinants of health needs

Care Advocate helping US members navigate Maven’s virtual women’s and family healthcare platform

Care Advocate helping US members navigate Maven’s virtual women’s and family healthcare platform.
Providing education, referrals, and care coordination across Maven’s digital health programs.

• Process incoming calls, faxes, and voicemails from claimants, providers, clients, attorneys, and others
• Resolve claims-related questions and issues according to guidelines and policies
• Communicate claim status and current claim activity with clients and appropriate medical contacts
• Respond to jurisdiction- and claim-specific inquiries
• Enter data into claims systems
• Ensure claim files are properly documented and claims coding is correct
• Coordinate claimant address updates or changes with internal departments
• Provide referrals to legal, utilization review, pharmacy, and Special Investigations Unit teams
• Coordinate independent medical examinations
• Support the organization’s quality programs
• Perform other duties as assigned

Consumer Care Advocate handling claims inquiries for Sedgwick’s risk and claims administration services

Consumer Care Advocate

Consumer Care Advocate handling claims inquiries for Sedgwick, a global risk and claims administration partner. Processing customer communications, documenting claims, and coordinating referrals and medical examinations.

• Screen Patients and Manage Intake You will call patients and ask health-related questions using a set script. These calls usually last 15 to 20 minutes. Your goal is to make patients feel comfortable so they share honest answers.
• Connect Patients to Resources You will ask questions to learn what each patient needs. Then you will share resources and send referrals to health and mental health services.
• Keep Accurate Records During each call, you will type patient responses into a health records system called an Electronic Health Record (EHR). You will review and finalize your notes before the end of each workday. All records must follow federal privacy rules (HIPAA) and billing standards. You will also collect and record patient consent at the start of each call.
• Manage Your Schedule You will keep your own daily calendar, send reminder calls to reduce missed appointments, and meet weekly goals. You will also schedule follow-up calls for patients and leave time between appointments to finish your notes.

Associate Care Advocate providing support to patients in their health journeys

Associate Care Advocate – Care Delivery

Associate Care Advocate supporting patients by connecting them to health services and resources. Involved in managing calls and maintaining accurate patient records for improved health equity.

Care Advocate jobs in Texas

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Quality Care Advocate – Clinical

Care Advocate

Consumer Care Advocate

Associate Care Advocate – Care Delivery