Project Manager, HEDIS Navigator

Regal Medical Group•Orange, CA

4d•Onsite

About The Position

The Project Manager, Navigator HEDIS will serve as the Medicare Stars health navigator to prioritize quality improvement efforts for BSC Medicare members and may include member outreach by scheduling appointments for targeted HEDIS measures and/or provider outreach for data reconciliation. The Project Manager Health navigator will play a crucial role in improving the provider organization’s Part C rating through member outreach and/or data retrieval. The health navigator’s role and responsibilities may include member outreach by scheduling appointments for targeted HEDIS measures and/or provider outreach for data reconciliation. The health navigator will work closely with the provider organization’s quality team and the assigned BSC program manager. The Health Navigator will provide monthly updates during scheduled meetings, maintain accurate tracking of patient outreach efforts, and coordinate with PCPs and specialists to ensure members remain compliant with all required preventive and chronic condition management services.

Requirements

Experience in patient outreach/advocacy.
Excellent organizational, communication, and problem-solving skills.
Ability to work independently and manage multiple tasks efficiently.
Proficiency in electronic medical records (EMR) and data tracking systems.
Intermediate or advanced MS Office proficiency.
Valid CA Drivers License & insurance.

Nice To Haves

Strong knowledge of Medicare and HEDIS preferred but not required.

Responsibilities

Member outreach by scheduling appointments for targeted HEDIS measures and/or provider outreach for data reconciliation.
Utilize the BSC HN tracker to outreach members with open care gaps to schedule necessary appointments.
Obtain medical records via provider outreach and/or EHR access, and work closely with the provider organization to ensure necessary documentation is properly submitted through supplemental data.
Complete the BSC HN Tracker accurately and submit it timely to the BSC program manager monthly.
Attend bi-weekly or monthly meetings and communicate barriers, progress, and updates.
Miscellaneous BSC program manager asks as it relates to HEDIS improvement for Medicare members.
Notify BSC program manager of any sick days or scheduled paid time off utilized as a FYI via e-mail.
Perform other work duties as assigned by management.