Job Description

The Project Manager, Navigator HEDIS will serve as the Medicare Stars health navigator to prioritize quality improvement efforts for BSC Medicare members and may include member outreach by scheduling appointments for targeted HEDIS measures and/or provider outreach for data reconciliation.

The Project Manager 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.

Responsibilities include

• 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.
• Patient Outreach & Scheduling: The health navigator will utilize the BSC HN tracker to outreach members with open care gaps to schedule necessary appointments.
• Medical Record Retrieval: The health navigator will obtain medical records via provider outreach and/or EHR access. The health navigator will work closely with the provider organization to ensure necessary documentation is properly submitted through supplemental data.
• BSC HN Tracker: The health navigator will be responsible for completing the tracker accurately and submitting it timely to the BSC program manager monthly.
• Attend bi-weekly or monthly meetings and communicate barriers, progress, and updates
• Miscellaneous BSC program manager asks as it related to HEDIS improvement for Medicare members
• Notify BSC program manager of any sick days or scheduled paid time off utilized as a FYI via e-mail
• Perform other work duties as assigned by management.

The pay range for this position at commencement of employment is expected to be between $70,304 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)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Qualifications

Qualifications and Skills:

• Experience in patient outreach/advocacy.
• Strong knowledge of Medicare and HEDIS preferred but not required.
• Excellent organizational, communication, and problem-solving skills.
• Ability to work independently and manage multiple tasks efficiently.
• Proficiency in electronic medical records (EMR) and data tracking systems.
• Intermediate or advanced MS Office proficiency
• Valid CA Drivers License & insurance