Remote - Bilingual HEDIS/QA Navigator

REMOTE - BILINGUAL QUALITY HEALTH NAVIGATOR

Description:

• Make outreach to members to help them with barriers to care and provide positive experience with our organization.
• Responsible for direct outreach and education to members with gaps in care for the purpose of increasing Medicare Star ratings and Medicaid Quality Incentive scores
• Educate members on the importance of routine preventive care as well as maintaining regular appointments for chronic conditions for themselves and/or their children.
• Increase HEDIS/QARR rates through increased member education and clinical care gap closure.
• Make outreach calls to support the Health Outcomes Survey to discuss fall prevention, physical/mental health, and help members address any barriers to care.

Required Experience:

• Bilingual (English & Spanish) - Highly preferred
• 1-3+ years' experience working in a related position (Claims review, clinical claims review, HEDIS, Managed Care)
• Knowledgeable about outpatient medical, managed care organization structure, and available community resources.
• Experience communicating directly with members, assessing member needs, providing general preventive health education, and connecting members with available resources.
• Proficiency with MS applications (word processing, database/spreadsheet, presentation/reporting)

Key Accountabilities:

• Outreach to members for health education, review members’ individual needs related to gaps in care, use community resources to facilitate medical care.
• Refer members to case management as needed and assist members with making appointments. Identify and escalate member concerns as needed.
• Collaborate with key functional areas such as care management, customer service, pharmacy to help members with barriers.

Details:

• 100% remote | Equipment provided.
• Schedule: Monday – Friday | 8:30am - 5:00pm (EST)
• Pay: $20/hr.
• Pay cycle – weekly | Medical, Dental & Vision Benefits offered.
• Start: 4/1/2024
• This will start as a 2-3 month contract/consulting position with an opportunity to be extended.

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.