Care Coordination Advocate - Remote

Overview

As a Care Coordination Advocate, you will play a crucial role in working collaboratively with our members, providers and internal Clearwater teams to guide members through their experience while accessing healthcare. Advocates play THE key role in coordinating member/patient care and delivering exceptional, thorough service.

In Short

• Review new cases for eligibility and qualifying benefits
• Coordinate members care/appointments with the member, provider and our preferred vendors
• Daily communication with members on the status of their case
• Update cases on an as needed basis
• Negotiate and establish Letters of Agreement (LOA), Single Case Agreements (SCA), Cash Pay Rates or Provider Contracts
• Assist and work closely with the Nurse Case Manager in managing member’s cases on a medical appropriateness level on an ongoing basis
• Work Provider Nominations to establish LOA’s with the nominated provider
• Review plan information, treatment and care, provider status etc. with Tier 2 members prior to their enrollment
• Review and negotiate post-service cases (balance bills) that are submitted by members
• Develop and maintain strong collaborative relationships with internal teams, members, and providers

Requirements

• Minimum of 2+ years of experience in the healthcare administration field
• 1+ years of experience in Advocacy, Prior Authorization or Case Management preferred
• Prior experience in a clinical setting is preferred
• Experience in team management is highly desirable
• Experience with Microsoft Office or similar
• Familiarity with Salesforce systems is advantageous
• Ability to communicate medical terminology and processes clearly to patients
• Strong organizational skills and ability to thrive in a fast-paced environment
• Excellent communication and customer service skills required
• Demonstrated ability to maintain accurate and up-to-date documentation in systems
• Thorough understanding of HIPAA regulations and commitment to maintaining patient confidentiality
• Strong prioritization skills, with the ability to manage multiple responsibilities effectively
• Proficiency in both verbal and written communication; bilingual skills are advantageous
• Passionate about fostering strong relationships with internal teams, members, and providers
• Legally authorized to work in the US

Benefits

• Competitive compensation
• Bonus opportunities
• Benefit packages
• PTO (unlimited or 3 weeks accrued depending on the role)
• 401K match
• Work from home reimbursement to set up your home office