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Corporate Functions & Operations WellCare - Customer Service Careers

Quality Improvement Care Gap Coordinator Job

Full Job Title: QI Care Gap Coordinator

Job Number: 1702122

Location: Phoenix, AZ

Date Posted: 6-1-2017

Location: E. Camelback Rd, Phoenix, AZ 85016
Department: Health Services-Quality Improvement
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.
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:
  • Required: High School Diploma or GED
  • Preferred: Associate's or Bachelor's Degree in a related field
Work Experience:
  • Required: 1 year of experience in member, provider and customer service or call center environment
  • Preferred: Health coaching experience
  • Preferred: Managed care experience
Additional Skills:
  • Knowledge of medical terminology and/or experience with CPT and ICD-9/10 coding
  • Demonstrated interpersonal/verbal communication skills
  • Demonstrated written communication skills
  • Ability to effectively present information and respond to questions from peers and management.
  • Data entry skills

Technical Skills:

  • Microsoft Word
  • Microsoft Excel

*LI-JC1


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Last Updated On: 12/9/2015