Make outreach to EmblemHealth members to help them with barriers to care and provide positive experience with EmblemHealth. Responsible for direct outreach and education to members with gaps in care for the purpose of increasing Medicare Star ratings and Medicaid Quality Incentive scores. 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.
* Outreach Emblem Health 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.
* BA/BS degree, Master's preferred
* LPN or higher required
* 1-3 years of experience working with members in medical or managed care environment required
* Knowledgeable about outpatient medical, managed care organization structure, and available community resources required
* Experience communicating directly with members, assessing member needs, providing general preventive health education and connecting members with available resources required
* Proficiency with MS applications (word processing, database/spreadsheet, presentation/reporting) required
* Bilingual Spanish/English preferred
* Requisition ID: 190EX
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.