Quality Outreach Unit Representative II - JHP

Elite B.CAesthetic; Philadelphia (Philadelphia County); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

Life and AD&D insurance

Disability and 401(k)

Job summary

Health Partners Plans, Inc. is seeking a Quality Outreach Representative II in Philadelphia to perform outbound calls, schedule PCP/specialist visits, and deliver exceptional member service within a fast-paced call center.

The role focuses on engaging members to close care gaps and support plan goals. The position emphasizes strong communication, bilingual abilities (Spanish preferred), and the ability to multitask in a collaborative team.

Qualifications

• High School Diploma or equivalent required.
• Excellent telephone communication.
• Bilingual preferred (Spanish).
• Ability to multitask in a fast-paced call center.
• Strong customer service skills.

Responsibilities

• Make outbound calls to members to schedule PCP/Specialist visits.
• Provide exceptional customer service and address member concerns.
• Coordinate care by contacting providers and arranging appointments.
• Document interactions in internal systems per policy.
• Assist in research projects related to quality improvement.

Skills

Telephone communication

Bilingual Spanish (preferred)

Customer service

Multitasking

Independent team work

Education

High School Diploma or equivalent

Job description

Job Details

The Quality Outreach Representative II is part of the Quality Improvement and Performance Team, working in a fast-paced call center environment. Quality Outreach Representatives make outbound calls to both new & existing HPP members to schedule PCP/Specialist visits as well as provide the members with exceptional customer service. Quality Outreach Representatives are responsible for member engagement through various outreach programs aimed at improving quality improvement initiatives and member satisfaction aligned with the organization’s HEDIS, Stars, and NCQA Accreditation goals. The main objective of this position is to proactively address members’ open gaps in care and provide our members the opportunity to voice any concerns about their plan and assist them to better manage their healthcare needs.

Job Description

Essential Functions

• Able to work in a constant state of alertness and safe manner
• Serve as front-line liaison between members and HPP, reaching out to members with care, compassion, patience, and professionalism to foster member satisfaction from the start
• Answer eligibility, benefit, and provider inquiries, assuring that members receive optimal service, take advantage of all available benefits and gain a high level of satisfaction with the plan
• Coordinate care for our members by conducting outreach calls and reminder calls to members, calls to providers to obtain appointments and test orders as well as coordinating multiple specialists’ appointments for members
• Collaborate with internal departments to facilitate resolutions to member issues and concerns
• Document appropriately in various internal systems as outlined by the supervisor and the Policy & Procedures of the department
• Operate telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange
• Assist the supervisor by taking on additional tasks and responsibilities to improve the overall productivity of the department
• Assist in the completion of various research projects related to quality improvement

Required Education And Experience

• High School Diploma or equivalent required.

Skills/Abilities

• Excellent telephone communication required; Bilingual preferred (Spanish).
• Ability to work independently and as part of a team required
• Exceptional customer service skills required
• Ability to multitask and work in a fast-paced call center environment required
• Computer literate, able to learn computer programs easily preferred

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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