Case Management Quality Outreach Specialist III

Medica • Minnetonka, MN

292d • $44,900 - $77,000

About The Position

Medica's Case Management Quality Outreach Specialist III assists in conducting targeted outreach to support our membership in achieving and maintaining optimal health. This individual will play a critical role in ensuring high quality healthcare for our members. This is a highly collaborative role that is positioned to support Medica's Case Management and Quality teams. This role will be aligned under Case Management with our Engagement team and will work closely alongside the Case Management team to support quality initiatives. A successful Quality Outreach Specialist will be skilled at telephonic work, including navigation of the health plan and community providers and facilities. This includes having exceptional skills in organization, prioritization, problem solving, and autonomy. Interpersonal and external provider/care system relationship skills are essential. Maintaining a strong working knowledge of numerous Medica sponsored and external health programs and services is also required. Our Quality Outreach Specialist will be responsible for leading telephonic outreach to members and providers for triage and steerage, driving targeted engagement and participation with quality outreach campaigns. The role will support the organization's quality improvement initiatives, enhance member outcomes, and improve coordination of services. This will be achieved through primarily outbound calls to identified members to provide education and assistance with access to care. This may also include making real-time (non-clinical) screening as to the most appropriate intervention for identified members. Additional responsibilities to include securing medical records from external providers and facilities to support quality standards with intent to close care gaps.

Requirements

• High School diploma or equivalent combination of education and work experience (bachelor's degree preferred).
• 3+ years' experience in a member-facing telephonic engagement and/or service support role.
• Experience in a customer service, call center, managed care or health care related environment strongly preferred.
• Experience collaborating with providers and other health professionals preferred.
• Familiarity and understanding of healthcare quality improvement standards and principles including HEDIS, Gaps in Care, Stars.

Nice To Haves

• Demonstrated autonomy and initiative in handling work.
• Strong analytical and problem-solving skills.
• Self-starter with strong organizational and communication skills.
• Ability to effectively facilitate phone conversations to engage members.
• Excellent communication and interpersonal skills.
• Experience working with diverse populations including seniors and those with disabilities.
• Advanced computer skills and application knowledge, specifically Microsoft Office applications.

Responsibilities

• Conduct targeted outreach to support membership in achieving and maintaining optimal health.
• Lead telephonic outreach to members and providers for triage and steerage.
• Drive targeted engagement and participation with quality outreach campaigns.
• Support the organization's quality improvement initiatives.
• Enhance member outcomes and improve coordination of services.
• Make outbound calls to identified members to provide education and assistance with access to care.
• Perform real-time (non-clinical) screening for appropriate interventions.
• Secure medical records from external providers and facilities to support quality standards.

Benefits

• Competitive medical, dental, vision insurance.
• Paid time off (PTO) and holidays.
• Paid volunteer time off.
• 401K contributions.
• Caregiver services.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Professional, Scientific, and Technical Services
• Education Level: High school or GED