Doctors HealthCare Plans, Inc. · 1 day ago
Quality/HEDIS Coordinator (Member Outreach)
United States
Full-time
Remote
Entry, Mid Level
2+ years expDoctors HealthCare Plans, Inc. is focused on improving healthcare quality and performance. The Quality/HEDIS Coordinator will support the health plan's quality goals by conducting member outreach to enhance medication adherence and close care gaps.
Health CareMedicalMedical Device
Responsibilities
Conduct outbound calls to members to encourage medication adherence, support prescription refills, and close HEDIS gaps in care
Educate members on the importance of taking medications as prescribed, while identifying and addressing any barriers
Contact provider offices to obtain prescriptions and clarify medication regimens
Contact pharmacies to verify prescription status, resolve access issues, and facilitate timely medication fulfillment
Communicate and collaborate regularly with internal teams, including Pharmacy and Provider Relations, as well as external vendors such as PBMs or adherence support partners
Assist with basic data analysis, including organizing and interpreting medication adherence data to help guide outreach strategies and inform internal and vendor teams
Document all member and provider interactions accurately in designated systems and escalate issues as needed
Monitor outreach outcomes and support continuous improvement in adherence initiatives
Maintain confidentiality and comply with HIPAA and organizational policies
Qualification
Required
Minimum of 2+ years of experience in a healthcare setting, with a focus on patient outreach, customer service or care coordination is strongly preferred
Experience with member or patient outreach, customer service, or care coordination strongly preferred
Knowledge of HEDIS measures, Medicare/Medicaid quality programs and mediation adherence is preferred
Understanding of medication adherence concepts and familiarity with pharmacy operations is a plus
Excellent verbal communication and interpersonal skills, with the ability to educate, motivate, and problem-solve over the phone
Comfortable making high-volume outbound calls to members, providers, and pharmacies
Proficient in Microsoft Office, specifically Excel and experienced with healthcare data systems or EMRs
Basic analytical skills, including experience working with spreadsheets (Excel or similar), and the ability to interpret and organize data effectively
Strong attention to detail, time management, and the ability to work both independently and as part of a cross-functional team
Commitment to maintaining confidentiality and complying with HIPAA and organizational standards
Bilingual in English/Spanish is required
Preferred
Minimum of 2+ years of experience in a healthcare setting, with a focus on patient outreach, customer service or care coordination is strongly preferred
Experience with member or patient outreach, customer service, or care coordination strongly preferred
Knowledge of HEDIS measures, Medicare/Medicaid quality programs and mediation adherence is preferred
Understanding of medication adherence concepts and familiarity with pharmacy operations is a plus
Company
Doctors HealthCare Plans, Inc.
Welcome to Doctors HealthCare Plans! Doctors HealthCare Plans, Inc., is a Florida-based, locally owned health plan providing coverage in Miami-Dade and Broward Counties and specializing in Medicare.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Ivonne Garrote-Torra
Chief Financial Officer
Recent News
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