Quality Improvement - Member Engagement Specialist 195-2018

Community Care•Tulsa, OK

14d

About The Position

The Quality Improvement - Member Engagement Specialist conducts outbound calls and other outreach to selected members and documents those efforts. The role spends 100% of its time on quality program activities and may involve extended or multiple calls with members, as well as additional projects as directed. Interventions are customized by objective and member demographics to close identified HEDIS gaps in care and achieve other quality improvement project objectives. The specialist helps members develop plans to resolve identified care gaps, arrange and travel to appointments, connect with external resources, and strengthen self-management behaviors. The role also compiles results for analysis and trending, identifies potential improvement opportunities, organizes outreach activities, and supports the development of campaigns, scripts, and other outreach methods. Additional duties may include project planning and collaboration with Quality Improvement Department staff on mailings, web-based outreach, on-site events, and other initiatives.

Requirements

High school diploma or equivalent.
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.
Three years of previous customer service experience.

Nice To Haves

Bachelor's degree in English, Communications, Social Science, Marketing, Business, or a similar field.
Bilingual ability.
Experience working with elderly people or in geriatrics.
Experience with face-to-face customer service.
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 and document outreach efforts.
Help members develop plans to resolve identified HEDIS gaps in care.
Assist members with setting up appointments and getting to and from appointments.
Share information about external resources, including Human Services and community services.
Encourage effective self-management behaviors.
Refer members with specific clinically related questions to a supervisor or Clinical Healthcare Coordinator, and refer other requests to Member Services.
Compile work results for analysis and trending.
Share potential opportunities for improvement with the supervisor based on member interactions.
Organize call lists and related activities for effective use of time.
Assist with developing call campaigns, call scripts, and other outreach opportunities, such as mobile apps and text messaging.
Perform other assigned duties, which may include project planning and collaboration with Quality Improvement Department staff on mailings, web-based outreach, on-site events, and other outreach opportunities.