Clever Care Health Plan Is Hiring A Hedis Risk Outreach Coordinator Bilingual

Join Our Team as a Bilingual HEDIS/Risk Outreach Coordinator! 🌟

Make a meaningful impact in healthcare! We're experiencing rapid growth and looking for dedicated bilingual professionals in Korean or Farsi to help us transform patient care and support underserved communities.

Overview

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.

Who Are We? 🤝

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.

Why Join Us? 🚀

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to:

• Make a real difference in patients' lives
• Shape the future of healthcare
• Be part of a dynamic, innovative organization that values diversity

Job Summary

The HEDIS/Risk Outreach Coordinator supports the deployment of Stars and Risk Adjustment programs through medical records retrieval, scheduling, and member outreach. This role involves collaboration with various teams such as Stars, Risk, UM/CM, Provider Relations, and Member Services, working closely with providers—including IPA, MSOs, and Physician Offices—to schedule appointments, education, and retrieval visits.

The coordinator will also engage in ongoing training and education on HEDIS, Stars, and Risk Adjustment measures to help close gaps in care.

Functions & Responsibilities

• Work with the Stars and Risk team to collect and review member records, contacting providers and logging results into specific databases.
• Facilitate provider notifications via fax or telephone using reports.
• Create PowerPoint decks and training materials for providers and staff.
• Maintain documentation to support quality improvement functions.
• Conduct telephonic and electronic outreach to patients.
• Perform HIPAA-compliant outreach to support medication adherence, utilization, and closing care gaps related to HEDIS and risk adjustments.
• Engage members in quality initiatives such as HEDIS or wellness care gaps, medication adherence, member experience, and health risk assessments.
• Assist with member outreach from provider offices as needed.
• Warm transfer calls to vendors when necessary.
• Identify barriers preventing patients from closing gaps and collaborate with care team members to support health management.
• Coordinate with vendors, providers, pharmacists, nurses, and patient care coordinators to address patient needs.
• Perform other duties as assigned.

Qualifications

• EMR experience is a plus, with willingness to travel to provider offices.
• Bachelor’s degree or at least 2 years of experience in health plan, managed care, or similar fields.
• Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment is beneficial.
• Valid driver’s license, reliable transportation, and insurance with a clean driving record.
• Experience in project management and meeting timelines.
• Strong organizational skills and attention to detail.
• Excellent communication, writing, proofreading, and grammar skills.
• Proficiency in MS Word, Excel, and PowerPoint.
• Familiarity with HEDIS technical requirements and HCC Risk Adjustment is a plus.

Wage Range 💰

Between $20 to $25 per hour.

Physical & Working Environment 🏢

• Must be able to travel as needed.
• Ability to operate a keyboard, mouse, and phone, with capacity for repetitive motions.
• Ability to sit for extended periods, stand, reach, bend, and lift up to 15 lbs.

Additional physical requirements may apply as needed to perform essential functions.