HEDIS Care Navigator

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

ROLE AND RESPONSIBILITIES

•Assists in educating Health Plan Members on the importance of addressing their HEDIS-related healthcare gaps.

•Assists Health Plan Members with scheduling HEDIS-related medical appointments, including those made with labs, diagnostic services, and specialty physicians.

•Assists Health Plan Members with addressing hurdles to schedule medical appointments, including transportation barriers.

•Provides follow-up appointment reminders via call, text, and/or email.

•Conducts follow-ups to verify Member completed appointments.

•Communicates with the Clinical team to support the work of HEDIS gap closures.

•Processes lab, DME, and other orders from Nurse Practitioners related to HEDIS gap closure.

•Updates and maintains accurate documentation of each member’s encounter in the electronic health record (EHR).

•Keeps accurate documentation of appointments made by member.

•Documents timely member observations, and clinical treatments/management requiring administrative notification of any critical member issues/concerns and laboratory values.

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 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.

Job Type: Full-time

Pay: From $16.00 per hour

Expected hours: No less than 40 per week

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Weekends as needed

Education:

• High school or equivalent (Required)

Experience:

• HEDIS: 1 year (Preferred)
• Healthcare management: 2 years (Required)
• EHR systems: 1 year (Required)
• Call center: 2 years (Required)

Ability to Commute:

• Olympia Fields, IL 60461 (Required)

Ability to Relocate:

• Olympia Fields, IL 60461: Relocate before starting work (Required)

Work Location: In person

Salary : $16