Required: Must live in the Chicagoland area.

Description:

• Acts as a liaison and member advocate between the member/family physician and facilities/agencies.
• Advises and educates Provider practices in appropriate measures and coding in accordance with requirements.
• Assesses provider performance data to identify and strategizes opportunities for provider improvement.
• Collaborates to improve provider performance.
• Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the providers office.
• Conducts face-to-face education with the member and their family in the providers 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.
• Interacts with other departments including customer service to resolve member issues.
• Refers to case or disease management as appropriate.
• Completes special assignments and projects instrumental to the function of the department.

Skills:

• Presentation
• Provider Engagement
• HEDIS
• Medicare advantage
• Site Visit
• Clinical Presentation
• Consultation

Required:

• Case managing experience
• Abstracting data for HEDIS measures
• LPN, LMSW, LCW, C-SW, OR Certified Medical Assistant OR Certified Nursing Assistant

Additional Skills & Qualifications:

• Total of 4 years of experience required for the position in improving quality care.
• Work experience should be in direct patient care social work quality improvement or health coaching preferably in a managed care environment.

Experience Level:

• Intermediate Level

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

• Hiring diverse talent
• Maintaining an inclusive environment through persistent self-reflection
• Building a culture of care, engagement, and recognition with clear outcomes
• Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.