HEDIS Care Navigator

Job Description

Job Description

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.
• Follows all Policies and Procedures of SCCP.
• Supports program compliance with Performance Goals/Contract Deliverables.
• Documents timely member observations, and clinical treatments/management requiring administrative notification of any critical member issues/concerns and laboratory values.
• Interacts with staff and members to optimize workflow efficiency.
• Participates in all SCCP mandatory and CMS regulatory training.
• Attends all staff meetings – in person or via telephone (if unable to attend, responsible for knowledge of content).
• Abides by all SCCP information security policies, procedures, protocols, and practices.
• Participates in regular information security management trainings.
• Develops a comprehensive understanding of SCCP information security policies.
• Learns to recognize information security risks and report them when they are identified.
• Abides by principles and laws related to confidentiality.
• Demonstrates respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).
• Other duties as assigned by Direct Report.

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.