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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: 1800323

Location: Louisville, KY

Date Posted: 1-13-2018

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.

REPORTS TO: DIRECTOR, QUALITY IMPROVEMENT
DEPARTMENT: KENTUCKY HEALTH SERVICES- QI-STATE
POSITION LOCATION: LOUISVILLE, KY 40223
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 is required
  • Associate's Degree or Bachelor's Degree is preferred
Experience:
  • 1-2 years of experience in member, provider and customer service or call center environment
  • Health coaching experience is preferred
  • Understanding of medical terminology
  • Experience in managed care is preferred
  • Appreciation of cultural diversity and sensitivity towards targeted populations
Special Skills (e.g. 2nd language):
  • Bilingual skills (English and Spanish) is preferred
  • Excellent communication skills
  • Data Entry skills
  • Ability to communicate effectively and professionally with members and providers
Technical Skills/Requirements:
Proficient in Microsoft Office (MS Word and MS Excel) *LI-RG1

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Last Updated On: 12/9/2015