HEDIS Care Navigator

SOUTHLAND CARE COORDINATION PARTNERS INC; Rich Township (IL); On-site; USD 52,000 - 70,000; Full time

Job summary

SOUTHLAND CARE COORDINATION PARTNERS INC seeks a HEDIS Care Navigator to facilitate HEDIS gap closures for Health Plan Members through proactive engagement. You will educate members about gaps and help them schedule and attend labs, diagnostics, and specialty appointments.

In this role you will address barriers such as transportation, provide reminders, and document every interaction in the EHR while collaborating with the HEDIS team and staying compliant with CMS and internal policies.

Qualifications

• High School Diploma or Equivalent required.
• Minimum of 2 years of general healthcare experience.
• EHR experience preferred.
• At least one year of HEDIS related experience preferred.
• Minimum of 2 years in a Customer Service role preferred.

Responsibilities

• Engage health plan members using professional techniques during verbal, electronic, and text-based communications.
• Educate Health Plan Members on addressing HEDIS gaps.
• Schedule HEDIS-related medical appointments, including labs and specialties.
• Assist with transportation and other barriers to scheduled visits.
• Provide follow-up reminders via call, text, or email.
• Collaborate with Clinical team to support HEDIS gap closures.
• Document encounters accurately in the EHR.
• Manage referrals, concerns, and grievances as applicable.
• Report critical member issues and laboratory values to management.
• Promote workflow efficiency and comply with policies and training.

Skills

Excellent verbal communication skills

Ability to interact with health care

Computer Literate - Word, Google Doc,

Able to multi-task

Coachable and teachable

Education

High School Diploma or Equivalent

Tools

EHR Systems

Job description

Description

Job Title: HEDIS Care Navigator

Program: HEDIS

Department/Group: Navigator Services

Direct Report: HEDIS Supervisor

Location: On site

Position Type: Full Time

Job Description: The HEDIS Care Navigator is responsible for facilitating HEDIS gap closures for Health Plan Members through effective Member engagement.

ROLE AND RESPONSIBILITIES

• Engage health plan members and employ professional techniques during verbal communications, electronic correspondence, and text-based interactions with each member.
• Assist in educating Health Plan Members on the importance of addressing their HEDIS-related healthcare gaps.
• Assist Health Plan Members with scheduling HEDIS-related medical appointment appointments, including those made with labs, diagnostic services, and specialty physicians.
• Assist Health Plan Members with addressing hurdles to scheduled medical appointments, including transportation barriers.
• Provide follow-up appointment reminders via call, text and or email.
• Communicate with the Clinical team to support the work of HEDIS gap closures.
• Update and maintain accurate documentation of each member’s encounter in the electronic health record (EHR).
• Properly execute member referrals/concerns/grievances when applicable.
• Document timely member observations, and clinical treatments/management requiring administrative notification of any critical member issues/concerns and laboratory values.
• Interact with staff and members to optimize workflow efficiency.
• Compliant with Performance Goals / Contract Deliverables.
• Help promote a company culture that encourages top performance and high morale.
• Follow all Policies and Procedures of SCCP.
• Participate in all SCCP mandatory and CMS regulatory training.
• Attend all staff meetings - in person or via telephone (if unable to attend, responsible for knowledge of content).
• Develop a comprehensive understanding of SCCP information security policies.
• Abide by all SCCP information security policies, procedures, protocols, and practices.
• Abide by principles and laws related to confidentiality.
• Report information security risks when they are identified.
• Participate in regular information security management trainings.
• Develop a comprehensive understanding of SCCP information security policies.
• Abide by principles and laws related to confidentiality.
• Demonstrate respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).
• Engage in continuing education and training for professional growth and development.
• Other duties as assigned by Direct Report.

Requirements

QUALIFICATIONS AND EDUCATION REQUIREMENTS

• High School Diploma or Equivalent Required.
• Minimum of 2 years of general healthcare experience.
• EHR experience preferred.
• At least one (1) year of HEDIS related experience is preferred.
• Minimum of 2 years in a Customer Service role preferred.

PREFERRED SKILLS

• Excellent verbal communication skills.
• Ability to interact with health care professionals in a professional manner.
• Computer Literate - Word, Google Doc and Excel.
• Able to multi-task, manage time and set priorities.
• Able to remain coachable and teachable at all times.