Quality/HEDIS Coordinator (Member Outreach)

Doctors HealthCare Plans, Inc.; Miami (FL); In loco; USD 42.000 - 56.000; Tempo pieno

Descrizione del lavoro

Doctors HealthCare Plans, Inc. is seeking a dedicated outreach specialist in Miami to support adherence initiatives and close HEDIS gaps. You will contact members, providers, and pharmacies to ensure prescriptions are filled and regimens followed, while collaborating with Pharmacy and Provider Relations teams.

Strong communication and data skills are essential. The role requires English/Spanish bilingual ability, HIPAA compliance, and experience with EMRs.

Competenze

• High school diploma or equivalent; Associate/Bachelor preferred
• 2+ years healthcare setting experience in outreach or care coordination desirable
• Experience with member outreach, customer service, or care coordination preferred
• Knowledge of HEDIS measures and Medicare/Medicaid quality programs preferred
• Understanding of medication adherence concepts and pharmacy operations a plus
• Excellent verbal and interpersonal communication skills for phone outreach
• Comfort with high-volume outbound calls to members, providers, and pharmacies
• Proficient with Microsoft Office; experience with healthcare data systems/EMRs
• Strong attention to detail and time management; able to work cross-functionally
• Bilingual in English/Spanish required

Mansioni

• Conduct outbound calls to members to encourage adherence and close HEDIS gaps
• Educate members on medication adherence and address barriers
• Contact providers to obtain prescriptions and clarify regimens
• Coordinate with pharmacies to verify status and resolve access issues
• Collaborate with Pharmacy, Provider Relations, and vendors on adherence efforts
• Assist with data analysis of adherence data to guide outreach strategies
• Document interactions in designated systems and escalate issues
• Monitor outreach outcomes and support continuous improvement
• Maintain HIPAA compliance and confidentiality

Conoscenze

Outbound calls

Healthcare outreach

HEDIS knowledge

Excel

HIPAA familiarity

Bilingual English/Spanish

Communication skills

Data analysis

Formazione

High school diploma

Associate/Bachelor preferred

Strumenti

EMR systems

Microsoft Excel

Descrizione del lavoro

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