Job Description

Job Description

Duties:

Purpose of Position: The primary function of the Quality Management Outreach Specialist is to provide support for internal and external requirements related to improving quality performance in its programs. This includes supporting processes related to collecting, maintaining and compiling data received for incorporation into Plan reporting. The position serves as a Quality Management member liaison, working to address member’s needs. The primary focus is outreaching to members to administer a Health Risk Assessment (HRA) and subsequently responding to identified needs, data entry of assessments, maintenance of tracking process and reports, and implementation of treatment plans by linking member to appropriate clinical and social services. This position will support additional ad-hoc outreach efforts to both members and providers to assist with connecting members to clinical services. Scope of Role & Responsibilities:

• Administer Health Risk Assessment to members as needed.

• Handle requests for care coordination, assessing the request, the member’s needs, and facilitating appropriate interventions and follow up.

• Maintain accurate and complete documentation of required information in compliance with risk management and regulatory requirements.

• Assist member with basic benefit information.

• Assist members with appointments for specialists, educational classes, and transportation.

• Perform data entry of medical information; maintain tracking process and reports.

• Assist Quality Management personnel to coordinate members’ appointments, equipment, social services, and home health needs.

• Participate in team meetings.

• Promote communication with the Care Management team and other internal departments to ensure members receive needed services and to foster member satisfaction.

• Alert the appropriate Team Lead when members share clinical issues that need to be addressed.

• Comply with all orientation requirements, annual and other mandatory training, organizational and departmental policies and procedures and actively participate in the evaluation process.

• Share observations and provide feedback regarding workflow to ensure continuous quality improvement. • Maintain professional competences as a Quality Management Outreach Specialist.

• Perform other duties as assigned

Skills:

One year of managed care experience preferably in Care Coordination Experience working with the health needs of the population served. Experience as a Medical assistant or Licensed Vocational Nurse is a plus. •One or more years of experience in the medical field. Managed Care Experience a plus.

•Strong customer service skills to coordinate service delivery including attention to members/caregivers, sensitivity to concerns, proactive identification and rapid resolution of issues to promote positive outcomes for members.

•Demonstrated ability to communicate effectively, problem solve and work effectively with people. •Bilingual candidates who are fluent in Spanish, Haitian Creole and/or Russian are strongly preferred. •Working knowledge of medical terminology and abbreviations.

•Proficiency with computers navigating in multiple systems and web-based applications.

•Confident, autonomous, solution driven, detail oriented, high standards of excellence, nonjudgmental, diplomatic, resourceful, intuitive, dedicated, resilient and proactive.

•Good interpersonal skills/team skills

•Understanding and appreciation for confidentiality

•Ability to work in a fast-paced environment

•Excellent time management and organizational skills

•Ability to prioritize and manage changing priorities under pressure

•Must know how to use Microsoft Office applications including Word, Excel, and Outlook. Professional

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto & home insurance, pet insurance, and employee discounts with preferred vendors.

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