Project Manager, HEDIS Navigator

Position Summary:

 

The Medicare Stars health navigator is a Blue Shield of California (BSC) funded role under the selected provider organization to prioritize quality improvement efforts for BSC Medicare members.

 

The health navigator will play a crucial role in improving the provider organization’s Part C rating through member outreach and/or data retrieval. The health navigator’s role and responsibilities may include member outreach by scheduling appointments for targeted HEDIS measures and/or provider outreach for data reconciliation. The health navigator will work closely with the provider organization’s quality team and the assigned BSC program manager. The Health Navigator will provide monthly updates during scheduled meetings, maintain accurate tracking of patient outreach efforts, and coordinate with PCPs and specialists to ensure members remain compliant with all required preventive and chronic condition management services.

 

Target Measures:

• Priority Part C Measures: EED, GSD, KED, CBP, BCS, COL, OMW
• BSC program manager may have ad-hoc requests for the health navigator to work on Care Coordination, Utilization, and Pharmacy measures on an as needed basis.

 

Additional Responsibilities and Requirements:

• The health navigator will be required to attend four (4) mandatory clinic days. One (1) of the four clinic days may be scheduled on a weekend, based on operating needs.
• Clinic assignments will primarily be located throughout the Los Angeles area, including Downtown Los Angeles, Chinatown, and La Habra, with the possibility of travel to additional clinic or community-based locations as needed.
• This role will support the organization’s growth initiatives, including the expansion of Health Navigator services to the San Diego and Temecula campuses.
• Flexibility to travel between assigned clinic locations and adapt to changing operations needs is required.

 

The pay range for this position at commencement of employment is expected to be between $71,760 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

 

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

 

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

 

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

  

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

 

Full Time Position Benefits:

 

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

 

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

 

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)