Excellus Health Plan Inc.
Rochester, NY
Job Description: This position acts as a quality improvement liaison with physician offices, community agencies, hospitals, and members to promote care management and quality programs. Acts as a member advocate by addressing gaps and barriers to care and educate appropriate use of services through outreach and pilot opportunities. The incumbent promotes programs and services available to Excellus members. Essential Accountabilities: Level I Explores multiple sources of information to identify members who have a gap in care, aligning with HEDIS quality measures and Value Base Payment programs. Assesses member's needs by applying Health Plan approved guidelines and assessment tools. Makes appropriate referrals to clinical programs. Provides outreach and education via telephone and written communication for members on health care quality metrics, assesses barriers to care, and intervenes as appropriate to assure access or facilitate referrals to other services for the...