Care Gap Specialist

About Us

Choice Consulting is a Collective, Holistic, Outreach, Inclusive, Community Empowerment organization designed to address Social Determinants of Health with evidence-based approaches to service delivery.

The Care Gap Specialist will work within a Medicaid Managed Care Organization (MCO) in Pennsylvania and will play a crucial role in ensuring that Medicaid beneficiaries receive comprehensive and timely healthcare.

Key Responsibilities:

Identifying Care Gaps:

Analyze patient data to identify gaps in care, such as missed screenings, vaccinations, or follow-up appointments.

Use electronic health records (EHRs) and other data sources to track patient compliance with recommended care guidelines.

Outreach and Engagement:

Contact patients to remind them of necessary appointments and screenings.

Educate patients about the importance of preventive care and adherence to treatment plans.

Coordination with Healthcare Providers:

Work closely with primary care physicians, specialists, and other healthcare providers to ensure coordinated care.

Facilitate communication between patients and providers to address barriers to care.

Data Management and Reporting:

Maintain accurate records of patient interactions and care gap closures.

Generate reports to track progress and identify areas for improvement.

Patient Assistance:

Assist patients in navigating the healthcare system and accessing resources.

Assist families and individuals in addressing social determinants of health and other barriers that prevent them from living a healthy life.

Skills and Qualifications:

Analytical Skills: Ability to analyze data and identify trends.

Communication Skills: Strong verbal and written communication skills for interacting with patients and healthcare providers.

Cultural Competence: Respect for differences in race, ethnicity, age, gender, sexual orientation, gender identity, religion, ability, and socio-economic circumstances; understanding and application of principles of cultural competence.

HIPAA Compliance: Knowledge of and adherence to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA). Ensure the protection and security of personal, confidential, and identifiable information in a professional and responsible manner.

Knowledge of Medicaid: Understanding of Medicaid regulations and managed care processes.

MA Renewal Assistance: On an ad hoc basis, support members in renewing their Medicaid/Medical Assistance/public benefits by providing guidance, reminders, and necessary paperwork assistance.

Organizational Skills: Ability to manage multiple tasks and prioritize effectively.

Other Duties: Perform other duties as assigned without notice.

Team Collaboration: Work with clinical and clerical teams to address gaps in service and preventive care.

Education/Experience

· Bilingual - English/Spanish is required.

· Bachelor’s Degree preferred or a minimum of 2-4 years of Work-Related Experience

· Experience with Medicaid, quality/HEDIS, member engagement, telephonic outreach

· Experience with Physical and Behavioral Health Medicaid/Managed Care

· Effective and strong communication skills.

· Respects differences of race, ethnicity, age, gender, sexual orientation, gender identity, religion, ability, and socio-economic circumstance; understands and applies principles of cultural competence.

· Must be able to handle multiple assignments and take initiative to plan and complete projects effectively.

· Must have knowledge of and maintain the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA). Ensure the protection and security of personal, confidential, and identifiable information in a professional and responsible manner and carry out all measures to prevent unauthorized disclosures.

· Proficient in MS Office (Word, Excel, and Outlook) within a Windows-based environment, Internet applications, and electronic documentation programs.

License/Certification:

• Valid Driver’s License
• Current Valid Car Insurance
• Successfully acquire Enrollment Assister Certification (after start date)

Physical Requirements:

· Must be able to remain in a stationary position 90% of the time.

· Constantly operates a computer and other office machinery such as a calculator, copy machine and printer.

· This position requires frequent communication with customers, community-based organizations, coworkers and members. Must be able to exchange accurate information in these situations by phone and in person.

· The ability to see details at close range.

· Ability to travel to provide assistance and resources to community and plan members.

Job Type: Full-time

Pay: $50,000.00 - $54,000.00 per year

Benefits:

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

Schedule:

• Monday to Friday

Work Location: In person

Salary : $50,000 - $54,000