Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Quality Health Navigator
Summary of Job
Responsible for the application of data analytics to prioritize members with possible gaps in care for the purpose of increasing Medicare Star ratings and Medicaid Quality Incentive scores. Educate members on the importance of routine preventive care as well as maintaining regular appointments for chronic conditions for themselves and/or their children. Increase HEDIS/QARR rates through increased member education and medical care gap closure. Make outreach calls to support the Health Outcomes Survey to discuss fall prevention, physical and mental health outreach.
Responsibilities
- Use analytics to identify Emblem Health members for health education; review members’ individual needs related to gaps in care; and community resources to facilitate medical care.
- Refer members to case management as needed and assist members with making appointments.
- Contribute to the ongoing development and advancement of the function’s community health strategies and activities.
- Collect, interpret, and disseminate/present data and information related to process and outcomes gleaned from telephone calls in all efforts pertaining to continuous quality improvement.
- Utilize HEDIS checklist in outreach efforts in order to identify gaps in clinical service outcomes.
- Maintain up-to-date knowledge and understanding of HEDIS/QARR/Star measure technical specifications.
- Provide clinical support related to assigned measures.
- Make recommendations on initiatives and outreaches based on knowledge of the specific clinical criteria of the measure.
- Provide information to clinical staff and telephonic outreach to ensure compliance with Clinical Practice guidelines, Preventive Health guidelines.
- Facilitate quality improvement activities to improve the delivery of quality health care to EmblemHealth members.
- Perform other related tasks as directed, assigned, or required.
Qualifications:
- BA/BS degree, master’s preferred
- LPN or higher required
- 3 – 5+ years of experience working with members in medical or managed care environment (Required)
- Knowledgeable about outpatient medical, managed care organization structure, and available community resources (Required)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
- Experience communicating directly with members, assessing member needs, providing general preventive health education and connecting members with available resources (Required)
- Proficiency with MS applications (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) (Required)
- Bilingual Spanish/English skills (Preferred)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.