Degreed Social Worker

Degreed Social Worker-Health Plan

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About this Role

Works with members and providers to close care gaps, ensure barriers to care are removed, and improve the overall member and provider experience through outreach and face-to-face interaction with members and providers at large IPA and/or group practices. Serves to collaborate with providers in the field, to improve HEDIS measures and provides education for HEDIS measures and coding. Supports the implementation of quality improvement interventions and audits in relation to plan providers. Assists in resolving deficiencies impacting plan compliance to meeting State and Federal standards for HEDIS. Conducts telephonic outreach, while embedded in the providers' offices, 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 when in the providers office for medical appointments. Schedules doctor appointments on behalf of the practitioner and assists member 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.

Job details

$30.52 / hour

Columbus, Ohio

New

Profession: Degreed Social Worker

Facility Type:

Specialty: Health Plan

Division: MedFi

Start Date: 12/04/2024

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Responsibilities

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

• Acts as the face of WellCare in the provider community with the provider and office staff where their services are embedded.

• Advises and educates Provider practices in appropriate HEDIS measures, and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.

• Assesses provider performance data to identify and strategizes opportunities for provider improvement.

• Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment, Operations (claims and encounters).

• Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider's office.

• Conducts face-to-face education with the member and their family, in the provider's office, about care gaps identified, and barriers to care.

• Conducts telephonic outreach and health coaching to members to support quality improvement, regulatory and contractual requirements.

• Arranges transportation and follow-up appointments for member as needed.

• Documents all actions taken regarding contact related to member.

Required Qualifications

• 2+ years healthcare experience

• Customer service experience required

• Bachelor's Degree in Healthcare, Public Health, Nursing, psychology, Social Work, Health Administration, or related health field

• Strong computer skills - MS office

• Provider Engagement/Reprsentative preferred

• RN/LPN/SW preferred