Member Engagement & Care Navigation Specialist

Blue Cross and Blue Shield of Massachusetts Inc.; Hingham (MA); On-site; USD 61,000 - 75,000; Full time

Benefits offered by this job

Paid time off

Health insurance (medical/dental/visi​

401(k)

Well-being benefits

Job summary

Blue Cross Blue Shield of Massachusetts is seeking a Member Engagement Specialist to connect with members, schedule appointments, and refer to care management to help achieve the best possible member health outcomes. The role emphasizes flexibility, collaboration, and proactive outreach to close gaps in care and improve NCQA and CMS STAR performance.

You will work within the HHIT in Clinical Quality and Compliance, coordinating with Care Management, Member and Provider Service, and Performance

Qualifications

• Excellent organization, communication, technical, customer service, and problem-solving skills.
• Knowledge of medical terminology, clinical data, and medical records.
• Ability to engage and obtain specific clinical information from members in a timely manner, to meet productivity while also serving our members’ needs.

Responsibilities

• Make outreach calls to members with gaps in care to assure adherence with HEDIS/STARs measures and contact provider offices to schedule appointments as needed.
• Escalate members to the HHIT Staff when clinical discussion is needed.
• Providing support of RN Provided Screening programs by scheduling and confirming patient appointments, documentation and faxing providers and other support functions as needed.
• Assist with non-clinical support needs from HHIT Staff including, but not limited to assisting members MyBlue registration, explaining gap related benefits and how to access benefits.
• Process faxed outreaches to providers by calling offices to confirm current patient status, obtaining fax number, sending fax and ensuring receipt of fax.
• Identify member barriers to obtaining care, promote appropriate resources, and make necessary referrals both internally and externally, to mitigate barriers.
• Ensure timely and clinically appropriate documentation in all required systems and meet daily productivity goals.
• Participate with Performance Measurement and Improvement in activities such as medical record reviews and provider outreaches.
• Provide onsite and virtual administrative support to the HHIT and Clinical Quality Team and for any associated improvement events (ex. Screening/Member events) as identified by Senior Manager.

Skills

Organization

Communication

Problem-solving

Education

Medical Assistant/Certified Pharmacy Technician

Senior/Medicare experience preferred

High school diploma or equivalent

Job description

Blue Cross Blue Shield of Massachusetts is seeking a Member Engagement Specialist to connect with members, schedule appointments, and refer to care management to help achieve the best possible member health outcomes. The role emphasizes flexibility, collaboration, and proactive outreach to close gaps in care and improve NCQA and CMS STAR performance.

You will work within the HHIT in Clinical Quality and Compliance, coordinating with Care Management, Member and Provider Service, and Performance