HEDIS Care Navigator

Job Title: HEDIS Care Navigator 

Program: HEDIS

Department/Group: Navigator Services 

Direct Report: HEDIS Supervisor

Location: On site 

Position Type: Full Time

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

ROLE AND RESPONSIBILITIES

• Engage health plan members and employ professional techniques during verbal communications, electronic correspondence, and text-based interactions with each member.
• Assist in educating Health Plan Members on the importance of addressing their HEDIS-related healthcare gaps.
• Assist Health Plan Members with scheduling HEDIS-related medical appointment appointments, including those made with labs, diagnostic services, and specialty physicians.
• Assist Health Plan Members with addressing hurdles to scheduled medical appointments, including transportation barriers.
• Provide follow-up appointment reminders via call, text and or email.
• Communicate with the Clinical team to support the work of HEDIS gap closures.
• Update and maintain accurate documentation of each member’s encounter in the electronic health record (EHR).
• Properly execute member referrals/concerns/grievances when applicable.
• Document timely member observations, and clinical treatments/management requiring administrative notification of any critical member issues/concerns and laboratory values.
• Interact with staff and members to optimize workflow efficiency.
• Compliant with Performance Goals / Contract Deliverables.
• Help promote a company culture that encourages top performance and high morale.
• Follow all Policies and Procedures of SCCP.
• Participate in all SCCP mandatory and CMS regulatory training.
• Attend all staff meetings – in person or via telephone (if unable to attend, responsible for knowledge of content).
• Develop a comprehensive understanding of SCCP information security policies.
• Abide by all SCCP information security policies, procedures, protocols, and practices.
• Abide by principles and laws related to confidentiality.
• Report information security risks when they are identified.
• Participate in regular information security management trainings.
• Develop a comprehensive understanding of SCCP information security policies.
• Abide by principles and laws related to confidentiality.
• Demonstrate respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).
• Engage in continuing education and training for professional growth and development.
• 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 is 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.