Job Description
Job Details Job Location Huntington Beach Office - Huntington Beach, CA
Secondary Job Location(s) Arcadia Office - Arcadia, CA
Position Type Full Time
Description 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, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation.
Job Summary The HEDIS/Risk Outreach Coordinator is responsible for assisting with the deployment and implementation of various Stars and Risk adjustment programs tied to medical records retrieval strategies, collecting and tracking medical records from offices and internal systems within the organization. The coordinator will also work closely with Stars, Risk, UM/CM, Provider Relations, Member Services and other Clever teams to schedule appointments for members and for scheduling education or retrieval visits with providers, which could be IPA, MSOs, Physician Offices. The coordinator will also be involved with continuous training and education on HEDIS, Stars and Risk Adjustment measures to close gaps in care.
Functions & Job Responsibilities - Candidate will work with the Stars and Risk team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific database.
- Facilitate fax or telephone call notification for providers utilizing reports.
- Create PowerPoint decks and other training materials for providers and staff.
- Collects and compiles the required documentation to maintain critical quality improvement functions.
Telephonic and electronic outreach to patients - HIPAA compliant outreaches to patients for Medication adherence/utilization and other risk/quality gaps closure support including but not limited to CAHPS and HEDIS/Risk gaps.
- Conducts member outreach for quality initiatives including HEDIS or wellness care gaps, medication adherence, member experience, Health Risk assessments, and other quality related outreach campaigns.
- May also be required to conducts member outreach from provider office as needed.
- Warm transfer of any calls to the vendors per the need of the project.
- Identifying barriers that prevent patients from closing any gaps and work with care team members to help patients be successful in managing their health.
- Coordinate with members of the patient care team, including vendors, providers, pharmacists, nurses, and patient care coordinators to address patient needs.
- Other duties as assigned.
(#LI-Hybrid)
Qualifications Qualifications Education and Experience: - EMR experience is a plus, must be okay with travel to provider offices.
- Bachelors degree or minimum two (2) years' experience in health plan, managed care or equivalent experience.
- Knowledge of CMS Star Programs, HEDIS, and Risk Adjustment are a plus.
- Valid driver's license, reliable transportation, and insurance required with clean driving record.
Skills: - Prior experience with project management/coordination and timelines
- Demonstrated effective organizational skills.
- Excellent communication, writing, proofreading and grammar skills
- Strong proficiency with MS Word, Excel, Power Point
- Excellent organizational skills and attention to detail
- Knowledge of HEDIS technical requirements and HCC Risk Adjustment is a plus.
Physical & Working Environment. Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:
- Must be able to travel when needed or required
- Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
- Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.
Wage Range: $20.00/hr - $25.00/hr
Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.
Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and public. May occasionally be required to work irregular hours based on the needs of the business.
Disclaimer The above information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this job.
Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate's state residency.
Job Tags
Full time, Work at office, Remote work,