Regular
Exempt
GENERAL DESCRIPTION:
Responsible for the monitoring of the various unit strategies and initiatives to ensure compliance of contacts with the Special Needs Plan (SNP) population to complete their Health Risk Assessment (HRA) and Comprehensive Health Risk Assessment (CHRA), monitoring social determinants evaluations, and compliance with face-to-face encounters.
ESSENTIAL FUNCTIONS:
Monitors the impact of outreach strategies for the Special Needs Plan (SNP) population, focusing on member compliance with Health Risk Assessment (HRA) and Comprehensive Health Risk Assessment (CHRA), social determinants interventions, and face-to-face encounters, according to the established work plan.
Monitors operational processes related to Special Needs Plan (SNP) strategies, ensuring productivity, compliance, and risk identification according to established standards.
Follows up with relevant departments to develop and implement corrective action plans, monitoring progress and completion of outstanding tasks.
Performs quality assessments and reconciliations of data loads and communication materials (e.g., reminder postcards, follow-up letters, self-assessments, refusal letters), maintaining evidence of compliance with operational protocols.
Maintains documentation and evidence of dispatch certifications for all outreach communications and strategies.
Tracks member compliance with face-to-face encounters and Comprehensive Health Risk Assessment (CHRA) reminders, as well as the evaluations and interventions related to social determinants of health.
Conducts regular meetings with operational teams to review progress and ensure compliance with member outreach and Health Risk Assessment (HRA) and Comprehensive Health Risk Assessment (CHRA) completion are met.
Prepares and submits reports to management summarizing strategy outcomes, risks, and compliance status.
Supports the department in documenting, designing, and implementing strategies aimed at achieving company goals.
Maintains effective communication with internal and external stakeholders, managing and escalating complaints in accordance with company procedures.
Identifies and reports risks or barriers to project objectives, recommending improvements to enhance service quality and cost efficiency.
Participates in unit meetings and educational activities as required to support ongoing professional development and operational effectiveness.
ADDITIONAL FUNCTIONS:
Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS:
Education and Experience: Bachelor's degree in Business Administration or related field. At least three (3) years of previous experience in project management related to Medicare regulations, data analysis, preferably in the Healthcare Industry.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses: N/A
Other: Proficiency in intermediate Excel, including data analysis and pivot tables, and the ability to accurately manage large data sets.
Languages:
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities."
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