HEDIS Outreach & Quality Improvement Specialist

Community Health Group; Chula Vista (CA); On-site; USD 52,000 - 70,000; Full time

Job summary

Community Health Group is seeking an HEDIS Outreach Specialist to enhance quality performance through member outreach, care coordination, and HEDIS reporting support. You will work with Epic, NextGen, and eClinicalWorks to retrieve documentation and support DSNP/CSNP members, scheduling and following up on preventive services.

The role requires strong communication, bilingual English/Spanish abilities, and ability to handle high-volume outreach, with occasional travel within the San Diego County

Qualifications

• Must have ability to influence, educate, and motivate members to complete healthcare services.
• Experience coordinating care and scheduling appointments with providers and vendors.
• Proficiency navigating Epic, NextGen, and eClinicalWorks and other EHR systems.
• Bilingual English/Spanish required.
• Excellent communication, interpersonal, and problem-solving skills.
• Knowledge of HEDIS, CMS STAR, and quality improvement programs preferred.
• Medical terminology preferred.

Responsibilities

• Supports interdepartmental workflows with effective communications.
• Conducts high-volume outreach to close HEDIS gaps and schedule preventive services.
• Coordinates member appointments with PCPs, specialists, labs, imaging centers, and vendors.
• Educates and motivates members to complete recommended healthcare services.
• Performs IHA outreach, scheduling, and follow-up for DSNP/CSNP members.
• Completes HEDIS abstraction training and performs chart reviews.
• Retrieves and organizes medical records for HEDIS reporting and audits.
• Navigates Epic, NextGen, eClinicalWorks to retrieve quality documentation.
• Provides HEDIS correspondence to members.
• Handles incentive program calls, eligibility, portal registration, and document uploads.
• Assists portal account creation and navigation.
• Researches and completes special projects to improve quality.
• Documents operational issues for escalation to Customer Services.
• Maintains professional image and confidentiality.
• Travel within San Diego County may be required.

Skills

Outreach & motivation

Care coordination

Member education

HEDIS awareness

IHA outreach

Education

High school diploma

Tools

Epic

NextGen

eClinicalWorks

Job description

Community Health Group is seeking an HEDIS Outreach Specialist to enhance quality performance through member outreach, care coordination, and HEDIS reporting support. You will work with Epic, NextGen, and eClinicalWorks to retrieve documentation and support DSNP/CSNP members, scheduling and following up on preventive services.

The role requires strong communication, bilingual English/Spanish abilities, and ability to handle high-volume outreach, with occasional travel within the San Diego County