Clever Care Health Plan Inc. Is Hiring A Hedis Risk Outreach Coordinator

Join us in making a meaningful difference in healthcare while being part of one of Southern California's fastest-growing Medicare Advantage plans, experiencing a remarkable 112% year-over-year membership growth! 🚀

Who Are We? 🌟

Clever Care was founded to serve the diverse communities of Southern California with innovative benefit plans that integrate Western medicine and holistic Eastern practices, aligning with our members' cultural and personal values.

Why Join Us? 💡

We are driven by a mission to make healthcare accessible for underserved populations. At Clever Care, you'll have the chance to:

• Make a genuine impact 🩺
• Shape the future of healthcare 🌍
• Be part of a dynamic, innovative, and diverse organization 🤝

Job Summary 📝

The HEDIS/Risk Outreach Coordinator will support the deployment of Stars and Risk Adjustment programs by managing medical records retrieval, coordinating member appointments, and facilitating education visits with providers. The role involves continuous learning and collaboration with various teams to improve healthcare quality and close care gaps.

Functions & Job Responsibilities ⚙️

• Work with the Stars and Risk teams to gather and review member records, then document findings in designated databases.
• Facilitate provider notifications via fax or phone using reports.
• Create training materials, including PowerPoint decks, for providers and staff.
• Collect and organize documentation to support quality improvement initiatives.
• Conduct HIPAA-compliant outreach via phone and electronic means to promote medication adherence and close care gaps, including HEDIS and CAHPS initiatives.
• Engage members for quality initiatives such as wellness checks, health risk assessments, and medication adherence programs.
• Perform outreach on behalf of providers as needed, and efficiently transfer calls to vendors when required.
• Identify barriers to care and collaborate with the care team to support patients in managing their health.
• Coordinate with vendors, providers, pharmacists, nurses, and care coordinators to address patient needs.
• Perform any other duties as assigned.

Qualifications 🎓

Education & Experience

• EMR experience is a plus; must be willing to travel to provider offices.
• Bachelor's degree or at least 2 years of experience in health plan or managed care settings.
• Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment is advantageous.
• Valid driver's license, reliable transportation, and insurance with a clean driving record.

Skills

• Strong project management and coordination abilities.
• Excellent organizational, communication, and writing skills.
• Proficiency in MS Word, Excel, PowerPoint.
• Attention to detail and understanding of HEDIS technical requirements and HCC Risk Adjustment are a plus.

Wage Range 💰

$20 to $25 per hour

Physical & Working Environment 🌍

Physical requirements include:

• Travel as needed
• Operating a keyboard, mouse, phone, and performing repetitive motions
• Sitting for extended periods, with the ability to stand, reach, bend, and lift up to 15 lbs
• Effective communication skills to convey information accurately and efficiently

Work environments include office settings and remote work, with frequent contact with staff and the public. Irregular hours may be required based on business needs.

Equal Opportunity Employment ✊

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action employer. We consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, age, marital status, disability, veteran status, or any other protected class. A background check is required.

Salary figures are based on California wages and may vary depending on the candidate's location.

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