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Quality Improvement Care Gap Coordinator

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.

2^nd 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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