The Quality Improvement (QI) Outreach Specialist supports Community Care Health’s Quality Improvement and Population Health Management (PHM) programs by performing LVN-level telephonic nursing assessment and executing member and provider outreach to support care gap closure, quality measure performance, and PHM initiatives. The role applies established clinical protocols to assess member needs, identify and document care gaps and clinical findings, and support appropriate escalation and follow-up within scope of practice. The position also supports HEDIS/HEQMS and preventive health and chronic condition initiatives, contributes to documentation and evidence collection for NCQA/accreditation readiness, and maintains accurate tracking and reporting of outreach activities under the direction of the Manager, Quality Improvement.
Work Schedule 8:00 AM – 4:30/5:00 PM (must remain consistent once established).
Ideal Candidate Traits:
- Strong verbal and written communication skills, including the ability to communicate professionally with members, providers, vendors, and internal stakeholders.
-
Ability to conduct high-volume outreach while maintaining documentation quality, accuracy, professionalism, and confidentiality.
-
Ability to identify barriers, unresolved issues, and member/provider concerns and escalate through established pathways.
-
Basic knowledge of health plan operations, Quality Improvement, Population Health Management, HEDIS/care gap activities, or member/provider outreach.
-
Ability to interpret basic clinical information (e.g., diagnoses, lab results, discharge summaries, medication lists, and care plans) to support identification of care gaps and appropriate follow-up actions within protocol guidelines.
-
Ability to apply LVN-level nursing judgment within established clinical protocols to determine appropriate outreach actions, prioritize member needs, and identify when escalation to RN or provider is required.
"Day in the Life":
