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HEDIS/Resource Coordinator

Company: Zolon Tech Solutions Inc.
Location: Newark
Posted on: January 14, 2023

Job Description:

Title : HEDIS/Resource Coordinator Location : Newark, DE Duration : 3+ Months Job Description:

  • As part of the care coordination team, the Resource Coordinator supports the development of and executes the outreach strategy in a certain territory for the purposes of influencing health outcomes and member engagement.
  • This position is responsible for establishing and cultivating relationships with members, community stakeholders, and providers.
  • Actively assisting providers in discharge planning for Level 1 members following acute episodes of care involving at a minimum one of the following services: inpatient psychiatric stay, ambulatory surgery, hospital inpatient stay, and rehabilitation facility services.
  • Assistance shall include but not be limited to appointment setting, referrals and linkages to services, coordination of DME, and coordination of prior authorizations as needed to support the member's timely access to services in the community
  • Assist in closing social determinants of health and care gaps through appointment assistance, coordinating transportation, connection to community resources and wellness programs
  • Establishes connection and acts as the primary ACFC contact to a targeted member population through home visits, community visits, and outreach calls.
  • Exercises judgment and discretion in the coordination of care by handling basic care follow-up tasks and collaborating with Caritas care coordination teams, community-based health care providers, and other organizations.
  • Informs members of the required actions to fulfill HEDIS, EPSDT, and Plan requirements and other referred outreach, through phone calls or home visits, and encourages them to comply.
  • Assists in addressing members' barriers to care and to encourage/foster relationships with their medical/dental providers (medical/dental homes).

Keywords: Zolon Tech Solutions Inc., Newark , HEDIS/Resource Coordinator, Other , Newark, Delaware

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