HEDIS HEALTH NAVIGATOR

Operation Samahan Mission

Building Healthier and Happier Communities Together       

Operation Samahan Inc. (OSI) is a federally qualified community health center that emerged over forty years ago. The agency serves low-income families and individuals in the County of San Diego in two (2) strategic areas with a high density population of Filipinos/Asian and other low-income, uninsured individuals — National City (Southern San Diego County) and Mira Mesa (North Central San Diego).

The Health Navigator coordinates with different health plans to ensure compliance issues based on the value of each health plan. Prepares reports on HEDIS measures and communicates the results to the different stakeholders. Visits each clinic to thread with other Patient Care Coordinators as needed. Monitors projects funded by the health plans. 

Health Navigator will work with Operation Samahan to identify a sustainment plan if the intervention of placing a health navigator works for their Blue Shield Promise membership in terms of HEDIS rate improvements. Efforts for improvement by health navigator will be focused but not limited to Well Child and Well Women measures. Assigned CPM will have weekly meetings with the Operation Samahan team and the health navigator to review detailed reports of the health navigator’s productivity and impact on Blue Shield Promise membership and rates. 

The Health Navigator is responsible for member engagement and brining members in for health screening to close gaps in care. The goal is to improve member relationships and preventative care outcomes through face-to-face member engagement by the Health Navigator.

HEDIS HEALTH NAVIGATOR POSITION 

ESSENTIAL DUTIES AND RESPONSIBILITIES: Other duties may be assigned

• Comply with department policy and procedures
• Obtain needed data from health plans regarding HEDIS measures
• Collect medical records, conduct reviews and ensure accuracy of documentation for reporting
• Assist in planning and implementation of projects to improve delivery of services and quality of care
• Perform patient outreach and scheduling to close care gaps
• Understand the principles of HEDIS and HIPAA
• Provide in-service training to providers regarding HEDIS and CMS Star Measures
• Generate and maintain accurate reports as required
• Attend to health plan, provider, and interdepartmental calls
• Perform other duties, projects, and actions as assigned

REQUIRED:

• Bachelor’s degree or equivalent years of experience
• At least 2 years of general healthcare experience, FQHC preferred
• At least one (1) year of HEDIS related experience preferred
• Experience explaining data reports to practitioners and educating providers
• Experience using Microsoft applications such as Word, Excel and Outlook
• Ability to drive in the state of California

Quality Management:

• Contribute to the success of the organization by participating in quality improvement activities.

Customer Relations:

• Maintain professional working relationships with all levels of staff, clients and the public.
• Be a team player and cooperate in accomplishing department goals and objectives.

Safety:

• Maintain current knowledge of policies and procedures as they relate to safe work practices.
• Follow all safety procedures and report unsafe conditions.
• Know location of nearest fire extinguisher and emergency exits.

HIPAA/Compliance:

• Maintain privacy of all patient, employee and volunteer information and access such information only on a need to know basis for business purposes.
• Comply with all regulations regarding corporate integrity and security obligations.   Report unethical, fraudulent, or unlawful behavior or activity.

Knowledge, Skills, and Abilities:

• Knowledge of the principles and practices of health education or medical knowledge.
• Knowledge of training methods, group dynamics, and community organization.
• Proficient in Windows and Microsoft applications including Word, Excel, Power Point, and Outlook.
• Must have a high level of organizational skills.
• Skill in planning, organizing, implementing, evaluating and administering health education programs. Skill in presenting information in-group settings.
• Skill in leading and coordinating the work of others.
• Ability to develop and maintain positive interpersonal relationships with a variety of people.
• Demonstrate effective verbal and written communication skills with staff, Board members, vendors, medical providers, and members of the general public.
• Complete many different duties, often changing from one task to another of a different nature without loss of efficiency or composure.
• Must be able to work under stress when confronted with critical or unusual situations.
• Must be able to follow instructions explicitly.
• Demonstrates ability to exercise analytic ability.
• Read and write, verbal and written communication, time management, and interpersonal skills.
• Prioritize, meet deadlines, and use sound judgment.

Education and Experience:

• Bachelor’s in Public Health, Health Education, Social Work or closely related field preferred.
• One-year experience providing medical information and dissemination.

Annual Requirements, Licensure, and Certifications

• Have reliable transportation; clean driving record, and car insurance as required by the state.

• Move throughout the clinic and community.
• Repetitive hand movement, use and view PC. Use fax, telephone, and copier.
• Sits or stand for long period of time, reach, bend, climb, stoop, and lift up to 25lb.

Reports to: Executive Director

FLSA Status: Non-exempt