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

All new hires must successfully pass a background screening as part of the onboarding process.