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Health Services WellCare - Clinical Support Careers

Care Gap Coordinator Job

Full Job Title: Care Gap Coordinator

Job Number: 1805049

Location: Houston, TX

Date Posted: 2018-07-27

Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and regulatory/contractual requirements. Provides education to members regarding the care gaps they have. Assists in scheduling doctor appointments via three-way phone calls and assists in scheduling transportation services, if needed. Maintains confidentiality of business and protected health information.

Reports To: Supervisor, Patient Care Advocacy

Department: Health Services - Quality & Analytics

Position Location: Houston, TX 77081

Essential Functions:
  • Conducts telephonic outreach to members to support Quality Improvement, regulatory and contractual requirements.
  • Educates the member and their family about preventive health screenings while identifying barriers to care.
  • Schedules doctor appointments for all household members with care gaps with the Primary Care Physician (PCP) and/or Specialist to access needed preventive care services and close gaps in care via a three-way phone call.
  • Informs providers about the care gap(s) member has and why they are seeing the provider.
  • Arranges transportation for members as needed.
  • Documents all actions taken regarding contact related to member.
  • Interacts with other departments including Customer Service to resolve member issues.
  • Refers to CM/DM as appropriate.
  • Completes special assignments and projects instrumental to the function of the department.
  • Performs other duties as assigned.
Education: High School Diploma. Associate's Degree or Bachelor's Degree strongly preferred
Experience: 1-2 years' experience in member, provider and customer service or call center environment. Health coaching experience a plus. Some understanding of medical terminology. Experience in managed care helpful. Appreciation of cultural diversity and sensitivity towards targeted populations.
Special Skills (e.g. 2nd language):
Bilingual skills (English and Spanish) a plus.
Excellent communication skills required.
Data Entry skills
Ability to communicate effectively and professionally with members and providers.
Technical Skills/Requirements: Proficient in Microsoft Office (Word, Excel).

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Last Updated On: 12/9/2015