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Corporate Functions & Operations WellCare - Customer Service Careers

Quality Improvement Care Gap Coordinator Job

Full Job Title: Quality Improvement Care Gap Coordinator

Job Number: 1706293

Location: Tampa, FL

Date Posted: 1-2-2018

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.
DEPARTMENT: Health Services-Quality Improvement
REPORTS TO: Manager Quality Improvement
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.
  • High School Diploma.
  • Associate's Degree or Bachelor's Degree strongly preferred
  • 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, Outlook).

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Last Updated On: 12/9/2015