10/16: Shortlisting done. HM will review candidates and schedule interviews
Location: Must do Field work within Lewes and nearby areas
Shift: Mon-Fri 8 a.m. 5 p.m. EST
No weekends or holidays
No OT
Duration: 3+ months contract
Description: Job Profile Summary: Our team is focused on three core initiatives: improving HEDIS performance, strengthening provider partnerships, and enhancing the member experience by reducing barriers to care. We are targeting high-impact preventive and chronic care measures to drive measurable year-over-year improvement. This role is essential in turning strategy into action. By conducting outreach, closing care gaps in real time, and addressing member barriers like transportation, the individual directly drives quality outcomes, improves provider performance, and enhances trust with members and practices.
" Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.
" Acts as the face of the client in the provider community with the provider and office staff where their services are embedded.
" Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
" Assesses provider performance data to identify and strategizes opportunities for provider improvement.
" Collaborates with Provider Relations to improve
Responsibilities" Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider s office.
" Conducts face-to-face education with the member and their family, in the provider s office, about care gaps identified, and barriers to care.
" Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.
" Arranges transportation and follow-up appointments for member as needed.
" Documents all actions taken regarding contact related to member.
" Interacts with other departments including customer service to resolve member issues.
" Refers to case or disease management as appropriate.
" Completes special assignments and projects instrumental to the function of the department.
" Will work at provider offices in Kent County and New Castle County 5 days a week
| Candidate Requirements |
| Education/Certification | Required: Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Social Work, Health Administration, or related health field or equivalent work experience required (a total of 4 years of experience required for the position) | Preferred: |
| Licensure | Required: NA | Preferred: RN, LPN, LMSW, LSW, Certified Social Worker |
Years of experience required: 2 years. Work experience should be in direct patient care, social work, quality improvement or health coaching preferably in a managed care environment.
Disqualifiers:
Additional qualities to look for: |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Excellent customer service skills |
| 2 | Member and/or patient outreach and care gap closure (telephonic and/or in-person) |
| 3 | Familiarity with Medicaid, Medicare Advantage, or dual populations |