Member Care Advocate Manager

About Wellth and Role Overview

Wellth is a healthcare technology company applying behavioral science and real-time engagement to enhance medication adherence, close care gaps, and improve health outcomes for members with high needs. Its platform integrates a daily member check-in app with an intelligent highlight engine and a human-in-the-loop Member Care Advocate (MCA) layer to deliver targeted support.

As Wellth expands into quality improvement programs including HEDIS, Medicare Stars, and chronic condition management, the MCA role is evolving from reactive support to proactive, data-guided care navigation. The MCA Manager will lead this transformative phase, managing day-to-day team operations while developing analytical systems to convert member data into actionable care interventions.

Key Responsibilities

• Aggregate member data from multiple sources such as the Wellth app, pharmacy, lab, claims, and partner health plans to create a unified, actionable view for advocates.
• Set and uphold data standards ensuring accurate measure statuses, medication possession ratio (PDC) calculations, and outreach histories before advocate engagement.
• Collaborate with Product and Engineering to present clear, prioritized member signals within care queues.
• Maintain and refine segmentation models to categorize members by engagement and clinical risk, guiding advocate focus.
• Translate clinical timelines and HEDIS measure logic into prioritization schedules ensuring focus on highest-impact members.
• Manage scoring formulas and escalation thresholds, adapting to results and evolving priorities.
• Identify members for whom MCA outreach is a proactive step, especially post-behavioral health discharge and transitions of care.
• Monitor trends and performance metrics to detect anomalies or rising health issues requiring intervention.
• Work with Quality teams to convert trend insights into program modifications and track effectiveness of interventions.
• Oversee the MCA team's daily workflows, ensuring appropriate member contact frequency and messaging effectiveness within measure action windows.
• Develop and update outreach materials, decision trees, and escalation protocols aligned with regulations and advocate feedback.
• Manage a personal caseload of complex cases to model best practices and stay connected to front-line challenges.
• Recruit, train, and cultivate a high-performing team culture emphasizing accountability, clinical insight, and empathetic communication.
• Conduct coaching sessions, call reviews, and performance evaluations; create scorecards measuring both activity and outcome-based metrics.
• Design career growth paths for advocates interested in clinical or analytical advancement.
• Serve as the main liaison for cross-functional teams on MCA processes, tools, and planning.

Collaborations and Reporting

• Work closely with Client Success, Operations teams, and external partners.
• Report directly to the Vice President of Quality for strategic guidance and leadership growth support.

Candidate Profile

• Minimum of 3 years' experience in case management, care coordination, or digital health coaching, including 1–2 years in a supervisory or leadership role.
• Familiarity with HEDIS measures and the ability to translate technical specifications into practical operational procedures.
• Proven experience managing or mentoring frontline care teams driven by performance metrics.
• Strong analytical skills to interpret cohort dashboards, identify anomalies, and convert findings into actionable team strategies.
• Excellent communication skills, able to author clear outreach scripts and present data insights to stakeholders.

Preferred Qualifications

• Experience working in digital health or health technology environments blending product, technology, and care delivery.
• Relevant clinical or community health credentials such as RN, LPN, LSW, or CHW.
• Familiarity with care management platforms, customer relationship management (CRM) tools, or health plan quality reporting systems.

Benefits and Work Culture

• Flexible, remote-first work environment with an optional on-site space in Marina Del Rey.
• Generous paid time off and parental leave programs.
• Competitive salary and equity packages.
• Comprehensive health, dental, vision insurance and FSA/HSA options.
• Opportunity to positively impact the health outcomes of vulnerable populations.
• Supportive, mission-driven team focused on advancing healthcare's future.

Compensation and Equal Opportunity

The base salary range for this position is $80,000 to $95,000 per year. Wellth is committed to equal employment opportunities and embraces diversity across all protected characteristics without discrimination.