Quality Health Navigator

Summary of Position :

Make outreach to members to help them with barriers to care and provide positive experience with (positive impact on CAHPS (consumer assessment of healthcare providers & systems).

Responsible for direct outreach and education to members with gaps in care for the purpose of helping members schedule appointments to help with gaps in care closure.

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.

Principal Accountabilities :

Outreach 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.

Qualifications :

BA / BS degree, Master's preferred.

1-3 years of experience working with members in medical or managed care environment.

Knowledgeable about outpatient medical, managed care organization structure, and available community resources.

Experience communicating directly with members, assessing member needs, providing general preventive healtheducation and connecting members with available resources.

Proficiency with MS applications (word processing, database / spreadsheet, presentation / reporting).

Bilingual Spanish / English (Highly preferred)

Comfortable working a temporary role.

Able to work an EST work schedule.

Benefits through CGC : Dental, Vision, STD and / or LTD, Voluntary Life & AD&D, Accident, Critical Illness, Hospital Indemnity, Health Advocate EAP, and Health Equity Commuter Benefits, ZayZoon, and 401k.

We are an equal opportunity employer and prohibit discrimination / harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws