Healthcare Improvement Quality Outreach Consultant

company • Village of Johnson City, NY

1d • $23 - $38

About The Position

This position acts as a quality improvement liaison with physician offices, community agencies, hospitals, and members to promote care management and quality programs. The consultant advocates for members by addressing gaps and barriers to care, educating them on appropriate use of services, and promoting programs and services available to Excellus members.

The position has Level I and Level II classifications. Level II includes the Level I accountabilities and qualifications, plus greater responsibility for mentoring staff, managing provider practices, supporting team decisions, reviewing performance metrics, and developing and implementing quality improvement programs.

Requirements

• At least three years of experience in health or human services for all levels.
• Associate degree in human services or a business-related field, or at least four years of direct provider and member contact in lieu of a degree.
• Experience with project management.
• Experience working with member populations from one or more lines of business: Commercial, SafetyNet, or Medicare.
• Experience giving formal or informal presentations to small or large audiences.
• Proficiency in Microsoft Office programs, including Word, Excel, and PowerPoint.
• Ability to work independently and as part of matrixed teams; self-motivation.
• Ability to problem-solve and resolve conflicts effectively.
• For Level II, at least five years of direct experience with the provider and member community.
• For Level II, excellent communication and presentation skills.
• For Level II, experience working with member populations from all lines of business: Commercial, SafetyNet, and Medicare.
• For Level II, subject matter expertise in HEDIS and VBP quality measures.
• For Level II, experience and demonstrated success with the PDSA process improvement cycle.
• For Level II, demonstrated knowledge of quality principles, especially root cause analysis and problem-solving.
• For Level II, knowledge of the health insurance industry, federal and state regulations, accreditation standards, and advancements from quality improvement organizations, including NCQA, CMS, The Joint Commission, and NYS DOH.
• For Level II, demonstrated leadership skills.
• Ability to travel across health plan service regions as needed.

Nice To Haves

• Bachelor’s degree.
• LPN or Medical Assistant qualification.
• Experience with iFacets claims processing and coding.
• Knowledge of preventive health activities and community agencies.

Responsibilities

• Identify members with gaps in care using multiple information sources and align outreach with HEDIS quality measures and Value Based Payment programs.
• Assess member needs using health plan-approved guidelines and assessment tools, and make appropriate referrals to clinical programs.
• Conduct telephone and written outreach and education about healthcare quality metrics; assess barriers to care and intervene to support access and referrals.
• Build relationships with providers and community agencies, advocate for members and their support systems, address social determinants of health, provide teaching, and refer members to case and disease management as needed.
• Collaborate with hospital executives and physician leaders to align performance and outcome measures with corporate HCI quality goals.
• Coordinate, present, and promote clinical programs to provider offices with Strategic Business Partners, Risk Adjustment, and Provider Relations; educate providers and community agencies about member services and programs.
• Pilot and collect data on methods for promoting quality health outcomes and help develop and maintain experience and health quality programs.
• Serve as a resource to healthcare improvement project teams working on gap closure.
• Lead project teams and serve as a subject matter expert to advance methods and interventions promoting quality health outcomes and programs.
• Communicate professionally with diverse members, physicians, and practice staff.
• Manage a caseload and maintain documentation in accordance with health plan standards.
• Meet or exceed departmental metrics, including call volumes, reach rate, and gap closure rate.
• Facilitate adherence to provider Service Level Agreements.
• Follow compliance standards and regulatory requirements, protect member privacy, demonstrate integrity and organizational values, and maintain regular and reliable attendance.
• Perform other functions as assigned by management.
• At Level II, prioritize work and guide, train, and mentor junior staff; collaborate with junior staff and contribute positively to the team.
• At Level II, manage key provider practices, serve as the decision point in the Supervisor’s absence, and alert the Supervisor to potential problems as an intermediary between staff and management.
• At Level II, collaborate with other departments on process and system changes, identify problems, and recommend effective solutions.
• At Level II, review metrics regularly and apply continuous quality improvement principles to improve process and outcome measures.
• At Level II, follow the PDSA model, review embedded practice outcomes at least quarterly, identify best practices, and pursue improvement opportunities with partner departments.
• At Level II, research best practices and healthcare improvement trends across health plans.
• At Level II, assist in developing and implementing innovative care management pilots and quality programs, and review and present outcomes to monitoring and planning committees and provider offices.

Benefits

• Competitive compensation and benefits, which may include group health and/or dental insurance, a retirement plan, wellness program, paid time away from work, and paid holidays.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree