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

• High School Diploma