Quality Outreach Unit Representative - JHP

Jefferson Health; Philadelphia (Philadelphia County); Hybrid; USD 36,000 - 50,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Tuition assistance

Retirement plans

Job summary

Health Partners Plans, Inc. seeks a Quality Outreach Unit Representative to engage members through outbound calls, address gaps in care, and improve HEDIS/CAHPS measures in a fast-paced call center.

You will coordinate care, educate members on benefits, document interactions, and collaborate with care management and enrollment teams to resolve issues and boost satisfaction.

Qualifications

• High School Diploma or GED required.
• Excellent telephone communication skills.
• Bilingual Spanish desirable.
• Ability to work independently and as part of a team.
• PC literate and quick to learn computer programs.
• Strong customer service orientation.
• Experience in a fast-paced call center is a plus.

Responsibilities

• Assist members via outbound calls and remind them of care options.
• Coordinate care by scheduling appointments and informing providers.
• Educate members about health plan benefits and services.
• Document interactions and maintain call records per policy.
• Collaborate with care management, enrollment, and member services to resolve issues.
• Maintain professionalism and compassionate communication to support member satisfaction.

Education

High School Diploma/GED

Tools

Call center software

Job description

A Quality Outreach Unit Representative is part of the Quality Outreach Team, responsible for member engagement through various outreach programs aimed at improving the organizations quality results and member satisfaction. Quality Outreach Reps performs in a fast-paced call center environment to make outbound calls to HPP membership to target HEDIS or CAHPS measures, member satisfaction, medication adherence follow-up calls, and other projects as assigned. The main objective of this position is to proactively address open gaps in care and provide our members the opportunity to voice any concerns about their plans and assist to help them to better manage their care and carry out strategies to increase health care adherence.**Job Description** **Summary** A Quality Outreach Unit Representative is part of the Quality Outreach Team, responsible for member engagement through various outreach programs aimed at improving the organizations quality results and member satisfaction. Quality Outreach Reps performs in a fast-paced call center environment to make outbound calls to HPP membership to target HEDIS or CAHPS measures, member satisfaction, medication adherence follow-up calls, and other projects as assigned. The main objective of this position is to proactively address open gaps in care and provide our members the opportunity to voice any concerns about their plans and assist to help them to better manage their care and carry out strategies to increase health care adherence. **Job Duties*** Assisting members via outbound telephone call, reinforcing to the member that HPP is available to them 24/7.* 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* Encourage the member to ask questions/express concerns regarding their plan for care.* Proactively assist members with scheduling medical appointments* Proactively seek and address Social Determinants of Health (SDOH) and Healthcare barriers* Educate callers about Health Partners Plans benefits with the intent of retaining members.* Report on trends and issues which impact all lines of business and member perception to management.* Collaborate with internal departments (such as HEDIS, care management, UM, enrollment, member services) to facilitate resolutions to member’s issues and concerns.* Serve as front line liaison between member and HPP, reaching out to member with care, compassion, patience, and professionalism to foster member satisfaction from the start.* Maintain call records, logs and other documentation in accordance with departmental requirements.* Operate MIS and telephone systems effectively and efficiently, following established protocols for security, transfer and information exchange.* Participate in appropriate staff meetings and training sessions, reporting on trends and issues which impact members and Health Partners as a whole.* Perform other clerical and support tasks as assigned. **Minimum Qualifications*** High School Diploma/GED* Excellent telephone communication; Bilingual desirable (Spanish).* Ability to work independently and as part of a team.* PC literate, able to learn computer programs easily* Exceptional customer service skills* Ability to work in a fast past call center environment **Preferred Qualifications*** 2 years customer service-related experience* Preferred knowledge of NCQA’s Health Plan Rating system (HEDIS, STARS, CAHPS) **Physical Demands** Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, \\*patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR. Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.**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 AmericaNationally 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.