Summary:

This position will be responsible for facilitating provider and member outreach to ensure member receipt of important clinical services to improve member health outcomes. Provides support for “Healthcare Effectiveness Data and Information Set” (HEDIS) quality initiatives and regulatory/contractual requirements including outreach to members who are non-compliant in the designated outreach services. Supports effective medical record capture for HEDIS medical record review and abstraction of supplemental data.

About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.

Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans. 

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.

What You'll Do:

• Integral part of the HEDIS team delivering member and provider education related to HEDIS care gaps.
• Works with provider sites to assist with member scheduling of appointments and education r/t coding guidelines for HEDIS.
• Responsible for scheduling and tracking of HEDIS-specific specialty clinics.
• Responsible for inbound/outbound call queue to assist members with appointment scheduling, HEDIS initiatives, education.
• Collaborate with the HEDIS team to deliver outreach initiatives to close care gaps.
• Distributes educational information to members and providers in accordance with the HEDIS outreach work plan (mailings, social media, automated calls, etc.).
• Conducts HEDIS provider chart request calls and mailings.
• Maintains an incentive database to track member compliance.
• May identify opportunities to partner with community organizations for special events and presentations (i.e., health fairs and community events).
• Works with internal staff to schedule, organize, and staff these events. Records and documents all member and provider outreach activity.
• Engages in HEDIS relevant provider relationships, record retrieval during MRR project, requiring travel to offices throughout Maryland 10-25%.

Knowledge and Skills:

• Proficiency in use of Microsoft Office Suite application software.
• Effective problem-solving skills to procure data and information.

Education and Work Experience:

• High school diploma or equivalent.
• Minimum of 3 years’ recent and related health care marketing, outreach, and/or health education experience.
• Recent and related experience working with HEDIS criteria; working in a call center environment. 

Requirements

• Travel 15-20% throughout the state of Maryland.
• Current driver’s license and reliable transportation.
• May require working outside of normal business hours to include evenings and Saturdays.

EEOC Statement: 

Following applicable federal, state, and local laws, MCMI prohibits discrimination in employment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, or any other characteristic protected by law. This commitment extends to all aspects of employment, including hiring, promotion, compensation, benefits, training, social and recreational programs, and all other conditions and privileges of employment. 

As a healthcare organization, we recognize the vital importance of inclusivity in delivering quality care to our patients. We strive to foster an environment where individuals of all backgrounds feel respected, valued, and supported. We aim to better comprehend the unique needs of our patients and provide healthcare services that are culturally competent and sensitive. 

We encourage candidates from all backgrounds to apply and join us in our mission to provide compassionate and inclusive healthcare. We believe that a diverse workforce enriches our organization and allows us to better understand, connect with, and serve our diverse patient population.