Quality/HEDIS Coordinator (Member Outreach)

Doctors-Healthcare-Plans,-Inc.; Coral Gables (FL); On-site; USD 42,000 - 54,000; Full time

Job summary

Doctors HealthCare Plans, Inc. is seeking a patient outreach specialist to support quality goals by closing HEDIS gaps in medication adherence.

You will conduct outbound calls to members, educate on prescribed regimens, and coordinate with providers and pharmacies to facilitate refills while addressing access issues. Collaborating with the Pharmacy Department, Provider Relations and external vendors, you will monitor outreach outcomes, document interactions, and help drive continuous

Qualifications

• Minimum 2+ years in a healthcare setting focused on outreach or care coordination.
• Knowledge of HEDIS measures and Medicare/Medicaid quality programs preferred.
• Bilingual in English/Spanish required.

Responsibilities

• Conduct outbound calls to members to encourage adherence and close HEDIS gaps.
• Educate members on prescribed regimens and address barriers to adherence.
• Contact providers to obtain prescriptions and clarify regimens.
• Coordinate with pharmacies to verify status and resolve access issues.
• Collaborate with Pharmacy, Provider Relations and external vendors regularly.

Skills

Outbound calls

HEDIS knowledge

Bilingual English/Spanish

Microsoft Excel

Education

High school diploma or equivalent

Associate’s or Bachelor’s degree in a healthcare-related field

Tools

EMRs / healthcare data systems

Job description

POSITION PURPOSE:

The purpose of this position is to support the health plan’s quality and performance goals, with a focus on achieving a 5-star rating for medication adherence measures. This includes conducting outbound calls to members to close HEDIS gaps in care, discussing the importance of medication adherence, contacting provider offices to obtain prescriptions, and working with pharmacies to facilitate prescription refills and resolve medication access issues. The role will also require ongoing communication and collaboration with the Pharmacy Department, Provider Relations, and any vendors contracted by the plan to support medication adherence efforts.

Key Responsibilities:

• Conduct outbound calls to members to encourage medication adherence, support prescription refills, and close HEDIS gaps in care.
• Educate members on the importance of taking medications as prescribed, while identifying and addressing any barriers.
• Contact provider offices to obtain prescriptions and clarify medication regimens.
• Contact pharmacies to verify prescription status, resolve access issues, and facilitate timely medication fulfillment.
• Communicate and collaborate regularly with internal teams, including Pharmacy and Provider Relations, as well as external vendors such as PBMs or adherence support partners.
• Assist with basic data analysis, including organizing and interpreting medication adherence data to help guide outreach strategies and inform internal and vendor teams.
• Document all member and provider interactions accurately in designated systems and elevate issues as needed.
• Monitor outreach outcomes and support continuous improvement in adherence initiatives.
• Maintain confidentiality and comply with HIPAA and organizational policies.

Qualifications:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in a healthcare-related field preferred.
• Minimum of 2+ years of experience in a healthcare setting, with a focus on patient outreach, customer service or care coordination is required.
• Experience with member or patient outreach, customer service, or care coordination strongly preferred.
• Knowledge of HEDIS measures, Medicare/Medicaid quality programs and mediation adherence is preferred.
• Understanding of medication adherence concepts and familiarity with pharmacy operations is a plus.
• Excellent verbal communication and interpersonal skills, with the ability to educate, motivate, and problem-solve over the phone.
• Comfortable making high-volume outbound calls to members, providers, and pharmacies.
• Proficient in Microsoft Office, specifically Excel and experienced with healthcare data systems or EMRs.
• Basic analytical skills, including experience working with spreadsheets (Excel or similar), and the ability to interpret and organize data effectively.
• Strong attention to detail, time management, and the ability to work both independently and as part of a cross-functional team.
• Commitment to maintaining confidentiality and complying with HIPAA and organizational standards.
• Bilingual in English/Spanish is required.

Our company is committed to creating a diverse environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP