HEDIS Care Navigator

Job Description

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

Role and Responsibilities

Assists in educating Health Plan Members on the importance of addressing their HEDIS-related healthcare gaps.

Assists Health Plan Members with scheduling HEDIS-related medical appointments, including those made with labs, diagnostic services, and specialty physicians.

Assists Health Plan Members with addressing hurdles to schedule medical appointments, including transportation barriers.

Provides follow-up appointment reminders via call, text, and/or email.

Conducts follow-ups to verify Member completed appointments.

Communicates with the Clinical team to support the work of HEDIS gap closures.

Processes lab, DME, and other orders from Nurse Practitioners related to HEDIS gap closure.

Updates and maintains accurate documentation of each member’s encounter in the electronic health record (EHR).

Keeps accurate documentation of appointments made by member.

Follows all Policies and Procedures of SCCP.

Supports program compliance with Performance Goals/Contract Deliverables.

Documents timely member observations, and clinical treatments/management requiring administrative notification of any critical member issues/concerns and laboratory values.

Interacts with staff and members to optimize workflow efficiency.

Participates in all SCCP mandatory and CMS regulatory training.

Attends all staff meetings – in person or via telephone (if unable to attend, responsible for knowledge of content).

Abides by all SCCP information security policies, procedures, protocols, and practices.

Participates in regular information security management trainings.

Develops a comprehensive understanding of SCCP information security policies.

Learns to recognize information security risks and report them when they are identified.

Abides by principles and laws related to confidentiality.

Demonstrates respect for individual diversity (culture, ethnicity, gender, race, religion, age, economic status).

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 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.

Full-time