Care Coordination Advocate

About the Role:

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. Reporting directly to the Manager of Care Coordination, you will perform the key administrative day-to-day operations of the department and ensure seamless communication and collaboration within the team. You will work closely with other Advocates, Bridge Department, Nurse Case Managers, members and providers on your assigned cases.

Role Responsibilities:

• 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 and providing support where needed
• 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

Key Competencies:

• 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