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: $17.00 per hour

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:

• Customer service: 2 years (Required)
• HEDIS: 1 year (Required)
• General Healthcare: 2 years (Required)
• EHR systems: 1 year (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 : $17