HEDIS Care Navigator

SOUTHLAND CARE COORDINATION PARTNERS INC•Olympia Fields, IL

14d•Onsite

About The Position

The HEDIS Care Navigator is responsible for facilitating HEDIS gap closures for Health Plan Members through effective Member engagement. This role involves direct interaction with members to educate them on healthcare gaps, assist with appointment scheduling, address barriers to care, and provide follow-up reminders. The navigator will also communicate with the clinical team, maintain accurate documentation in the EHR, and ensure compliance with performance goals and company policies.

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.

Nice To Haves

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.

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.
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.