Quality Improvement - Member Engagement Specialist 195-2018

CommunityCare, Inc.; Tulsa (OK); On-site; USD 21,000 - 30,000; Full time

Job summary

CommunityCare, Inc. is seeking a dedicated outreach-focused professional to perform outbound member calls and support plan development to close gaps in care. The role centers on quality program activities and may involve extended calls, coordination with clinicians, and collaboration on additional projects.

The position emphasizes strong communication, organizational skills, and experience with healthcare services, with potential involvement in various outreach channels and community resources.

Qualifications

• Knowledge of HMO plans, enrollment, benefits and claims.
• Experience interacting effectively with diverse individuals.
• Highly organized with strong attention to detail.
• Proficient in Microsoft Office applications.
• Excellent problem-solving skills.
• Bilingual abilities preferred.
• Strong oral and written communication skills.
• Health Care Sanctions background.

Responsibilities

• Contact members for intervention and help develop plans to close identified HEDIS gaps.
• Compile results for analysis and share opportunities for improvement with supervisor.
• Organize call lists and related activities for efficiency.
• Assist with development of call campaigns, scripts, and outreach (apps, text messaging).
• Collaborate on other outreach projects (mailings, web outreach, on-site events).

Skills

Knowledge of HMO plans

Interpersonal skills

Highly organized

Microsoft Office

Problem solving

Bilingual preferred

Oral and written communication

Health Care Sanctions background

Education

High school diploma or equivalent

Bachelor's degree preferred

Elderly/geriatrics experience preferred

Face-to-face customer experience

3 years customer service experience

Healthcare/insurance/medical office experience preferred

Claims examining experience preferred

Cross-trained on multiple lines of business

Tools

Microsoft Office

Job description

JOB SUMMARY:

Responsible for completing out-bound calls and other member outreach opportunities to select members and documenting efforts. This role spends 100% of time on quality program activities.May require extended, or multiple, phone calls to members.May require work on additional projects as directed.

KEY RESPONSIBILITIES:

• Contact members selected for intervention. Assist members with developing a plan to resolve identified HEDIS gaps in care, setting up appointments, getting to and from appointments, sharing information on external resources such as Human Services and community services, and encouraging effective self-management behaviors. Refer members with specific clinically-related questions to supervisor, or Clinical Healthcare Coordinator and/or to Member Services to address other requests.


• Compile results of work for analysis and trending. Share potential opportunities for improvement with supervisor based on interaction with members.


• Organize call list and related activities for effective use of time.


• Assist with development of call campaigns, call scripts and other outreach opportunities (for example mobile apps, text messaging, etc). Interventions are customized by objective and member demographics to close identified HEDIS gaps in care and achieve other QI Project objectives.


• Perform other duties as assigned, including but not limited to project planning and collaboration with other QI Department staff on other outreach opportunities (mailings, web-based outreach or on‑site events, etc).

QUALIFICATIONS:

• Knowledge of HMO plans, enrollment, benefits, and claims.


• Demonstrated ability to relate and interact effectively with all types of individuals.


• Highly organized and attentive to detail.


• Proficient in Microsoft applications


• Excellent problem solving skills.


• Bilingual preferred.


• Possess strong oral and written communication skills


• Successful completion of Health Care Sanctions background.

EDUCATION/EXPERIENCE:

• High school diploma or equivalent. Bachelor's degree in English, Communications, Social Science, Marketing, Business or similar preferred.


• Experience working with elderly or geriatrics preferred.


• Experience with \"face to face\" customer experience,


• Three years previous customer service experience. Managed healthcare, insurance industry, or medical office/clinic preferred.


• Prior claims examining experience preferred.


• Cross trained and functional on three or more lines of business.