Roles & Responsibilities
The Quality Improvement Outreach Coordinator drives performance improvement maximizing member compliance for Verity’s Value-Based Shared Savings Program by conducting telephonic outreach to Medicaid recipients enrolled with a Managed Care Organization. Position expectations include assisting members with locating a primary care provider, scheduling appointments via 3-way call, appointment reminder calls, and scheduling transportation services as needed. Position requires excellent communication skills and a desire to connect with members focusing on the importance of their healthcare needs.
Responsibilities include but are not limited to:
-
Manage assigned member outreach (appointment calls, quality measures due, annual wellness visits, follow-up calls, etc.) by closing gaps in care and increase HEDIS scores.
-
Tracking and trending of inbound/outbound calls by documenting accordingly per policy.
-
Provide member education on preventive care screenings and assist with scheduling appointments to close gaps in care.
-
Serves as a resource contact and information/education source to patients, families, providers, and/or staff.
-
Meet departmental goals and objectives by supporting Quality initiatives
-
Input alerts in EMR (if applicable) to notify providers/staff of current outstanding items due for completion.
-
Maintain knowledge of HEDIS specifications in accordance NCQA guidelines
-
Assist the HEDIS Abstractor Specialist in the coordination and preparation of the HEDIS medical record review, which includes medical record requests, collection, abstraction, documentation, and organization
-
Follow all departmental Policies and Procedures for compliancy.
-
Helps with special projects, as assigned by Director
-
As directed and supervised by Director, assists in the attainment of members’ goals by:
- Working with member, physician, other care providers to meet the member’s individual needs based on protocols and referrals,
-
Calling the identified member to offer a review of the program,
-
Supporting the member education goals based on the Plan of Care,
-
Informing the member how to access resources,
-
Assisting in the arrangement of Provider follow-up appointments and delivery of care,
-
Mailing of approved educational and informational materials,
-
Assisting in the performance of calls to members post discharge from inpatient or other levels of care,
-
Supporting the monitoring and evaluation of interventions in the Plan of Care.
Qualifications
-
Healthcare-related experience is preferred.
-
Demonstrated relationship building and influential skills.
-
Outstanding Customer Service and follow-up skills.
-
Strong organizational and time management skills, able to work with little supervision.
-
Excellent written/verbal communication skills, especially the ability to communicate telephonically in a professional and effective manner.
-
Computer literacy in Microsoft Office Suite (Excel, Word, Outlook, Power Point) and Internet navigation.
-
Ability to multi-task in a fast-paced environment
Education Requirements
