HEDIS/Risk Outreach Coordinator (bilingual Chinese)

Clever Care Health Plan•Huntington Beach, CA

6d•$20 - $25•Hybrid

About The Position

This position operates on a hybrid work schedule, requiring 3 days onsite at the Huntington Beach office. Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. We are on a mission to make healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.

Requirements

EMR experience is a plus, must be okay with travel to provider offices.
Bachelors degree or minimum two (2) years' experience in health plan, managed care or equivalent experience.
Valid driver’s license, reliable transportation, and insurance required with clean driving record.
Prior experience with project management/coordination and timelines
Demonstrated effective organizational skills.
Excellent communication, writing, proofreading and grammar skills
Strong proficiency with MS Word, Excel, Power Point
Excellent organizational skills and attention to detail

Nice To Haves

Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment are a plus.
Knowledge of HEDIS technical requirements and HCC Risk Adjustment is a plus.

Responsibilities

Assist with the deployment and implementation of various Stars and Risk adjustment programs tied to medical records retrieval strategies.
Collect and track medical records from offices and internal systems within the organization.
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.
Be involved with continuous training and education on HEDIS, Stars and Risk Adjustment measures to close gaps in care.
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.
May also be required to conduct member outreach from provider office as needed.
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.
Other duties as assigned.