Quality Improvement - Member Engagement Specialist 195-2018

CommunityCare • Tulsa, OK

16d

About The Position

Responsible for completing outbound calls and other member outreach opportunities to selected members and documenting those efforts. The role spends 100% of its time on quality program activities and may involve extended or multiple phone calls to members, as well as additional projects as directed. The specialist supports members in resolving identified HEDIS gaps in care, compiles work results for analysis, organizes outreach activities, and contributes to the development of outreach campaigns and materials.

Requirements

• Knowledge of HMO plans, enrollment, benefits, and claims.
• Demonstrated ability to relate to and interact effectively with all types of individuals.
• Highly organized and attentive to detail.
• Proficiency in Microsoft applications.
• Excellent problem-solving skills.
• Strong oral and written communication skills.
• Successful completion of a Health Care Sanctions background check.
• High school diploma or equivalent.
• Three years of previous customer service experience.
• Experience with face-to-face customer service.

Nice To Haves

• Bilingual ability.
• Bachelor's degree in English, Communications, Social Science, Marketing, Business, or a similar field.
• Experience working with elderly people or in geriatrics.
• Experience in managed healthcare, the insurance industry, or a medical office or clinic.
• Prior claims examining experience.
• Cross-trained and functional on three or more lines of business.

Responsibilities

• Contact members selected for intervention.
• Help members develop plans to resolve identified HEDIS gaps in care, set up appointments, arrange transportation to and from appointments, access information about external resources such as Human Services and community services, and practice effective self-management behaviors.
• Refer members with clinically related questions to a supervisor or Clinical Healthcare Coordinator, and refer other requests to Member Services.
• Compile work results for analysis and trending, and share potential improvement opportunities with a supervisor based on member interactions.
• Organize call lists and related activities to use time effectively.
• Assist with developing call campaigns, scripts, and other outreach opportunities, including mobile apps and text messaging. Customize interventions according to objectives and member demographics to close identified HEDIS gaps and meet other QI project objectives.
• Perform other assigned duties, including project planning and collaboration with QI Department staff on outreach such as mailings, web-based outreach, and on-site events.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED