HEDIS & Risk Outreach Specialist | Hybrid

Paycom; Huntington Beach (CA); Hybrid; USD 28,000 - 34,000; Full time

Job summary

Clever Care Health Plan is seeking a HEDIS/Risk Outreach Coordinator in Huntington Beach, CA. You will deploy Stars and Risk adjustment programs, gather medical records, and schedule education or retrieval visits with providers to close care gaps.

The role requires coordinating with Stars, Risk, UM/CM, and Provider Relations teams, while ensuring HIPAA-compliant outreach and data integrity across internal systems.

Qualifications

• Bachelor's degree or minimum two (2) years' experience in health plan, managed care or equivalent experience.
• Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment are a plus.
• EMR experience is a plus, must be okay with travel to provider offices.

Responsibilities

• Collect member records and conduct reviews by contacting providers and entering results into a database.
• Facilitate fax or telephone notifications for providers using reports.
• Create training materials (PowerPoint decks) for providers and staff.
• Coordinate with Stars, Risk, UM/CM, Provider Relations and other Clever teams to schedule appointments.

Skills

Project management/coordination

Excellent communication

Organizational skills

Education

Bachelor's degree

2 years health plan/managed care experience

Tools

MS Word

Excel

PowerPoint

Job description

Clever Care Health Plan is seeking a HEDIS/Risk Outreach Coordinator in Huntington Beach, CA. You will deploy Stars and Risk adjustment programs, gather medical records, and schedule education or retrieval visits with providers to close care gaps.

The role requires coordinating with Stars, Risk, UM/CM, and Provider Relations teams, while ensuring HIPAA-compliant outreach and data integrity across internal systems.