HEDIS/Risk Outreach Coordinator (Bilingual Korean)

Clever Care Health Plan • Huntington Beach, CA

353d • $20 - $25 • Hybrid

About The Position

The HEDIS/Risk Outreach Coordinator is responsible for assisting with the deployment and implementation of various Stars and Risk adjustment programs tied to medical records retrieval strategies, collecting and tracking medical records from offices and internal systems within the organization. The coordinator will also work closely with Stars, Risk, UM/CM, Provider Relations, Member Services and other Clever teams to schedule appointments for members and for scheduling education or retrieval visits with providers, which could be IPA, MSOs, Physician Offices. The coordinator will also be involved with continuous training and education on HEDIS, Stars and Risk Adjustment measures to close gaps in care.

Requirements

• Bachelors degree or minimum two (2) years' experience in health plan, managed care or equivalent experience.
• EMR experience is a plus, must be okay with travel to provider offices.
• Valid driver's license, reliable transportation, and insurance required with clean driving record.
• Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment are a plus.

Nice To Haves

• Prior experience with project management/coordination and timelines
• Knowledge of HEDIS technical requirements and HCC Risk Adjustment is a plus.

Responsibilities

• Work with the Stars and Risk team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database.
• Facilitate fax or telephone call notification for providers utilizing reports.
• Create PowerPoint decks and other training materials for providers and staff.
• Collect and compile the required documentation to maintain critical quality improvement functions.
• Conduct HIPAA compliant outreaches to patients for medication adherence/utilization and other risk/quality gaps closure support including but not limited to CAHPS and HEDIS/Risk gaps.
• Conduct member outreach for quality initiatives including HEDIS or wellness care gaps, medication adherence, member experience, Health Risk assessments, and other quality related outreach campaigns.
• Warm transfer of any calls to the vendors per the need of the project.
• Identify barriers that prevent patients from closing any gaps and work with care team members to help patients be successful in managing their health.
• Coordinate with members of the patient care team, including vendors, providers, pharmacists, nurses, and patient care coordinators to address patient needs.

Benefits

• Equal Employment Opportunity and Affirmative Action workplace
• Background check required

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees