care advocate

CorVel Corporation

<div>
 The Care Advocate Nurse oversees initiatives surrounding assessing the severity of the injured workers&rsquo; reported injury(ies), reviews medical data in CareMC, validates and secures medical information, assesses and evaluates prescribed treatment of work related injury. The Care Advocate Nurse functions as a nurse consultant, supporting the goals of the Claims Management department and of CorVel.
 
 
 This is a remote role.
 
 
 
 Essential Functions &amp; Responsibilities
 
 
 
 <ul>
 <li>
 Initiates and receives telephonic contact with reported injured worker, employer and medical providers to obtain treatment plan, secures medical documentation, and assesses if injured worker has returned to work
 </li>
 <li>
 Responsible for detailed documentation within the claim system focusing on medical condition, treatment plan and return to work status
 </li>
 <li>
 Directs callers to appropriate medical and/or claim resources
 </li>
 <li>
 Identifies and communicates urgent situations related to treatment or patient condition directly to the claim team
 </li>
 <li>
 Functions as nurse consultant to the claim team
 </li>
 <li>
 Assesses appropriate medical follow-up and makes necessary recommendations to the claim team, working closely with team to assist in identifying potential red flags from the injury that may require further follow-up or additional services
 </li>
 <li>
 Adheres to the Care Advocate Nurse production standards and Account special handling guidelines
 </li>
 <li>
 Additional duties as assigned
 
 
 </li>
 </ul>
 
 Knowledge &amp; Skills
 
 
 
 <ul>
 <li>
 Fundamental concepts, practices and procedures of early intervention in the field of Workers&rsquo; Compensation (WC)
 </li>
 <li>
 Excellent verbal and written communication skills
 </li>
 <li>
 Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet production standards deadlines and maintaining strong customer service orientation
 </li>
 <li>
 Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Outlook, Word, and Excel spreadsheets
 </li>
 <li>
 Strong interpersonal skills
 </li>
 <li>
 Great attention to detail, and results focused
 </li>
 <li>
 Ability to work independently and as part of a team
 
 
 </li>
 </ul>
 
 Education/Experience
 
 
 
 <ul>
 <li>
 Minimum of 2 years' clinical nursing experience
 </li>
 <li>
 Graduate of an approved accredited school of nursing
 </li>
 <li>
 Current unencumbered RN Licensure in state of residency and practicing state(s) must be maintained throughout employment with CorVel
 
 
 </li>
 </ul>
 
 Pay Range
 
 
 
 CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
 
 
 For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
 
 
 Pay Range: $61,053 - $98,334
 
 
 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
 
 
 In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
 
 
 
 About Corvel
 
 
 
 CorVel, a certified Great Place to Work&reg; Company, is a national provider of industry-leading risk management solutions for the workers&rsquo; compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
 
 
 A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
 
 
 
 CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
 
 
 
</div>

Care Advocate Nurse

Hays

<div>
 
 Job Title: Customer Care Advocate
 
 
 Location: Remote from California (must live in California)
 
 
 
 
 *Please communicate with candidates that time off during training is not approved by the business. The full training is from 5/4/2026 &ndash; 6/19/2026.
 
 
 Virtual classroom training is from 5/4/26 &ndash; 6/3/26, and nesting is from 6/3/26 &ndash; 6/19/26.
 
 
 
 
 Role Value Proposition
 
 
 As a leader in insurance, client never underestimates the significance of the impact made by associates. We are actively hiring Customer Care Advocates for our Dental team! As a Customer Care Advocate, you will receive in-bound customer service inquiries via the telephone and/or email and resolve problems by putting customers at the heart of all you do. The successful candidate will leverage effective listening skills, mindfulness, strong intellectual curiosity, and an honest desire to be effective and ensure each customer experience is exceptional. With an understanding of the customers&rsquo; needs and wants, and a focus on delivering solutions that meet those needs, you will deliver a service experience that exceeds expectations and makes it easy for customers to do business with us.
 
 
 
 
 Key Responsibilities
 
 
 
 
 Virtual roles work from a home office.
 
 
 Respond to dental customer requests via telephone or email, providing excellent service to client's customers who have insurance products or benefit plans.
 
 
 Research requests regarding various product aspects, policy provisions, claim status, basic procedures, etc.
 
 
 Efficiently process transactions and refer requests for other policy modifications to appropriate areas. Track responses to ensure completion.
 
 
 Enhance and strengthen the relationship between the customer and clients using effective communication skills, keen listening skills and empathy.
 
 
 Efficiently access and navigate multiple electronic systems to provide a complete and integrated response to the customer&rsquo;s inquiry.
 
 
 Perform these responsibilities in a consistent, professional manner while exercising strong verbal, interpersonal and high-quality service skills.
 
 
 
 
 Required:
 
 
 New hires should reside in the State of California.
 
 
 High School Diploma or GED equivalent.
 
 
 1 year of experience in customer service customer (includes call center, retail, and restaurants).
 
 
 The ability and desire to work during the hours of operation 5 AM to 8 PM PST, Monday through Friday. Applicants must be flexible regarding shift worked with an understanding that shifts are based-on business need.
 
 
 Ability to navigate across multiple computers monitors and programs (including Word, Salesforce, and Insight) at one time while conversing with a customer.
 
 
 
 
 Preferred:
 
 
 Prior Call Center or Customer Service Representative experience is preferred.
 
 
 Strong computer/keyboard skills (ability to type efficiently).
 
 
 Experience handling dental or other types of insurance products.
 
 
 Prior experience in a dental office.
 
 
 Superb listening skills and professional oral communication skills to inspire trust and accountability though in an empathetic style which promotes a quality image of client.
 
 
 Previous experience with Salesforce is a plus.
 
</div>

Customer Care Advocate

Allegheny Health Network

<div><h2 class="jobSectionHeader">Company :
</h2>Allegheny Health Network
<h2 class="jobSectionHeader">Job Description :
</h2>GENERAL OVERVIEW:
This job is responsible for answering calls received into the centralized call center. The Representative will use the appropriate procedures, tools and equipment to answer inquiries to provide First Call Resolution as often as possible. This level of representative will handle routine inquiries which will have a well-defined protocol as well as some more complex inquiries. 
 
ESSENTIAL RESPONSIBILITIES
<ul><li>Phone work - Assisting patients with all requests and specialties during business hours (8:00am-5:00pm). Promptly answers a multiple line telephone system and processes complex medical service requests in a confidential manner with strict adherence to policies and procedures. Ascertains the reason for a patient's call. Follows established protocol and uses independent judgment to appropriately refer a patient to a physician or specialist as necessary. Maintains department productivity levels for customer satisfaction. (85%)
</li><li>Working with leadership on professional development, Maintains department productivity levels for customer satisfaction. (10%)
</li>Performs other duties as assigned or required by management. (5%) 
<li>
</li></ul> 
QUALIFICATIONS:
Minimum
<ul><li>High School/GED
</li><li>Customer service OR Physician scheduling experience 
</li></ul> 
Preferred
1 year in a Call Center role 
<ul><li>
</li></ul> 
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
 
 
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. 
 
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company&rsquo;s Handbook of Privacy Policies and Practices and Information Security Policy.
 
 
Furthermore, it is every employee&rsquo;s responsibility to comply with the company&rsquo;s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$19.00
Pay Range Maximum:
$27.74
Base pay is determined by a variety of factors including a candidate&rsquo;s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice</div>

Patient Care Advocate

Centene

<div>You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility. 
Position Purpose: 
Supports the efforts of the clinical team through collaboration with prescribers and targeted beneficiaries in order to ensure appropriate, evidence-based drug selection and resolve medication-related problems.<ul><li>
Provides medication therapy management (MTM) services via triage of inbound calls to the MTM hotline, monitors fax line for prescriber responses and completion of failed faxes, supports the pharmacist for completion of Comprehensive Medication Reviews (CMRs) through pre-work up and case preparation, communicates with network pharmacies, prescribers, and beneficiaries to provide MTM services.</li><li>
Documents and records services/activities in appropriate databases/software to ensure compliance with CMS requirements for clinical service offerings assigned in designated area.</li><li>
Engages in drug utilization review (DUR) by supporting the execution of DUR initiatives via meeting preparation, letter campaigns, and telephonic outreach to members/providers.</li><li>
Supports basic data analytic activities and tracking of interventions, and assists with preparation and documentation of responses to regulatory audits associated with the over utilization program.</li><li>
Performs other duties as assigned.</li><li>
Complies with all policies and standards.</li></ul>
Education/Experience: 
High School or GED required, 0-1 year of experience in pharmacy operations managed care, hospitals, and/or retail environments. 
 
Licenses and Certifications: Certified Pharmacy Technician (CPhT) Preferred 
Location: Prefer candidate to live in KY.
Hours: 8-5 EST
Pay Range: $15.87 - $27.25 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. 
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act</div>

Pharmacy Technician Care Advocate

WellCare of Kentucky

<div>
 You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you&rsquo;ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 
 
 
 Position Purpose
 
 
 
 Supports the efforts of the clinical team through collaboration with prescribers and targeted beneficiaries in order to ensure appropriate, evidence-based drug selection and resolve medication-related problems.
 
 
 <ul>
 <li>
 Provides medication therapy management (MTM) services via triage of inbound calls to the MTM hotline, monitors fax line for prescriber responses and completion of failed faxes, supports the pharmacist for completion of Comprehensive Medication Reviews (CMRs) through pre-work up and case preparation, communicates with network pharmacies, prescribers, and beneficiaries to provide MTM services.
 </li>
 <li>
 Documents and records services/activities in appropriate databases/software to ensure compliance with CMS requirements for clinical service offerings assigned in designated area.
 </li>
 <li>
 Engages in drug utilization review (DUR) by supporting the execution of DUR initiatives via meeting preparation, letter campaigns, and telephonic outreach to members/providers.
 </li>
 <li>
 Supports basic data analytic activities and tracking of interventions, and assists with preparation and documentation of responses to regulatory audits associated with the over utilization program.
 </li>
 <li>
 Performs other duties as assigned.
 </li>
 <li>
 Complies with all policies and standards.
 
 
 </li>
 </ul>
 
 Education/Experience
 
 
 
 High School or GED required, 0-1 year of experience in pharmacy operations managed care, hospitals, and/or retail environments.
 
 
 
 Licenses And Certifications Certified Pharmacy Technician (CPhT) Preferred
 
 
 
 
 Location Prefer candidate to live in KY.
 
 
 
 Hours 8-5 EST
 
 
 Pay Range $15.87 - $27.25 per hour
 
 
 Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
 
 
 Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
 
 
 Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
</div>

CVS Health

<div>We&rsquo;re building a world of health around every individual &mdash; shaping a more connected, convenient and compassionate health experience. At CVS Health&reg;, you&rsquo;ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger &ndash; helping to simplify health care one person, one family and one community at a time.
Position Summary 
The Medicaid Member Advocate is a key position in the MHP (Mental Health Professional) Promise Agreement, which is a specialized managed care program in West Virginia designed for children in foster care, kinship care, and adoptive care, aligned with Aetna Better Health of West Virginia as its single managed care organization.
Job duties include:<ul><li>
Responsible for interacting with the population and ensuring that our members are referred and connected to appropriate resources.</li><li>
Collaborating with Care Management Director, Mountain Health Promise care coordinators, System of Care Administrators, and the SNS (Socially Necessary Services) Liaison.</li><li>
Providing member support related to enrollment, access, and continuity of care issues.</li><li>
Supporting members throughout any grievances of appeal activities.</li><li>
Assisting members in obtaining materials in alternative formats, as applicable.</li><li>
Supporting and addressing needs of children and youth in foster care with educational needs by collaborating with transition specialists, care managers, and others that provide a supportive transition.</li><li>
Serving as an advocate for members by creating a bridge between them and community programs or resources.</li><li>
Supporting our youth's socio-psychological needs (such as security, love, approval, independence and/or achievement), specifically through individual support systems or goals, in an effort to help youth achieve support and independence.</li><li>
Supporting the transitional-aged youth with ensuring socio-psychological needs are met appropriately.</li><li>
Ensuring the IEP (Individualized Education Program) credits and needs are supported for a smooth transition from residential to community.</li><li>
Performing other duties as needed.</li></ul> 
Required Qualifications<ul><li>
3-5 years of experience in healthcare, specifically working with low-income and foster care population.</li><li>
Must reside in West Virginia.</li><li>
Willingness to travel up to 10% within the state of West Virginia.</li></ul> 
Preferred Qualifications<ul><li>
5+ years of experience working in foster care or low-income populations.</li><li>
Proficiency documenting needs, efforts, and outcomes in tracking systems/CRMs (such as QuickBase) and managing multiple member cases.</li><li>
Strong verbal and written communication skills.</li><li>
Culturally sensitive, trauma‑informed, and empathetic approach when interacting with members and families.</li><li>
Excellent organization and time‑management skills, with the ability to prioritize urgent needs.</li><li>
Collaborative mindset and ability to work effectively with multidisciplinary teams and community partners.</li><li>
Problem‑solving skills to navigate complex legal, educational, welfare, and housing systems.</li><li>
Reliability and consistency in attending required meetings/rounds and completing documentation.</li><li>
Bachelor Degree in Social Work, Education or Counseling.</li></ul> 
Education<ul><li>
Bachelor&rsquo;s Degree.</li></ul>
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$46,988.00 - $91,800.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in our comprehensive and competitive mix of pay and benefits &ndash; investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul><li>
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li><li>
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li><li>
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li></ul>
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 04/02/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.</div>

Medicaid Member Advocate (West Virginia)

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Medicaid Member Advocate (West Virginia)