SUMMARY:

Works with members and providers to close care gaps, assist with medication refills, identify barriers to care, and improve the overall member and provider experience through outreach with members and providers. Conducts telephonic outreach to members who are identified as needing preventive services in support of quality initiatives and provides education to members regarding the care gaps they have. Assist with scheduling doctor appointments on behalf of the member and assists with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available. Maintains confidentiality of business and protected health information.

Reports to: Manager, Quality & Strategy Engagement

Location: Houston, TX
 

EDUCATION:

• Bachelors or Associates Degree in related field or two (2) years related experience
 

LICENSES/CERTIFICATIONS:

A license in one of the following is preferred:

• Pharmacy Technician (CPhT)

• Licensed Vocational Nurse (LVN)

• Registered Nurse (RN)

• Social Worker (LSW)
 

EXPERIENCE:

• Work experience should be in direct patient care, social work, quality improvement or health coaching

preferable in a managed care environment.

• Knowledge of CMS STAR Ratings Program requirements preferred.

• Knowledge of HEDIS and NCQA requirements preferred.

SKILLS:

• Knowledge of healthcare delivery

• Strong oral communication skills

• Ability to work in a fast paced environment with changing priorities

• Ability to work with others in a matrixed environment

• Demonstrated written communication skills

• Demonstrated time management and priority setting skills

• Demonstrated problem solving skills

• Demonstrated organizational skills

RESPONSIBILITIES:

• Acts as a liaison and member advocate between the member/family, physician and facilities/agencies.

• Schedules doctor appointments for members with care gaps to access needed preventive care services

• Conducts telephonic outreach to members at risk for medication non-adherence and provides assistance as needed with obtaining medication refills.

• Conducts telephonic outreach to members and providers to support quality improvement & risk adjustment

initiatives

• Arranges transportation for members as needed.

• Arranges follow-up appointments for member as needed.

• Documents all actions taken regarding contact related to member.

• Interacts with other departments including customer service to resolve member issues.

• Refers to case or disease management as appropriate.

• Completes special assignments and projects instrumental to the function of the department.

• Performs other duties as assigned.

TECHNICAL SKILLS:

• Working knowledge of Microsoft Office

• Working knowledge of Electronic Health Records (EHR)

About Apex Health Solutions

Apex Health is a tech-enabled management services organization transforming how health systems unlock value from their physician networks and succeed in value-based care. More than a consultant, Apex embeds as a long-term partner to drive sustainable performance across provider enablement, quality, network growth, and value-based care. With proven success at leading health systems, Apex helps clients preserve local control over care delivery and financing, rather than outsourcing it to national insurers.