Quality Outcomes Associate

Position Summary

The Quality Outcomes Associate (QOA) plays a key role in supporting high-impact Population Health programs through provider and member outreach, education, and engagement. This position is essential to driving continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) measures, including Medicare Stars and Medicaid QARR.

Essential Position Functions/Responsibilities

• Facilitate provider and member outreach to promote timely clinical interventions that improve health outcomes.
• Sustain communication strategies aligned with the external-facing roles of Network Relations and the Customer Engagement Center (CEC).
• Identify potential resources and initiate collaboration with providers to improve member health outcomes and HEDIS measures.
• Maintain a strong understanding of HCP’s brand recognition and communication efforts.
• Conduct outbound calls to members to provide reminders, guidance, and assistance in obtaining services to avoid delays in care and support improved health outcomes.
• Collaborate with internal teams to ensure accurate understanding and achievement of quality and risk adjustment metrics.
• Serve as a quality resource for providers and field specialists, addressing questions and offering guidance on quality initiatives.
• Support internal teams in educating providers and implementing quality and risk adjustment programs through targeted interventions.
• Distribute educational materials to providers and members in accordance with HEDIS and Population Health work plans.
• Accurately document member participation in outreach activities in line with abstraction and audit standards.
• Conduct HEDIS chart request outreach to providers via calls and mailings.
• Support the implementation and tracking of member incentive programs related to HEDIS measures.
• Record and maintain detailed documentation of all outreach activities with members and providers.
• Support Population Health programs and perform additional duties as assigned.
• Assist with CAHPS-related outreach calls as needed.

Qualification Requirements

• Strong attention to detail, with the ability to plan, execute, and follow up on tasks accurately and efficiently.
• Excellent verbal and written communication skills, including experience engaging with medical providers in a professional manner.
• Proven ability to multitask, prioritize responsibilities, and work independently in a fast-paced environment.

Skills, Knowledge, Abilities

• Associate’s degree or an equivalent combination of education and relevant experience is required.
• Bachelor’s degree in a healthcare-related field is preferred.

Experience

• Minimum of 1 year of experience with Healthcare Effectiveness Data and Information Set (HEDIS) data collection and quality improvement activities.
• At least 3 years of recent experience in a healthcare setting (e.g., managed care organization, provider office, hospital, clinic, or pharmacy).
• Experience working in a professional, corporate office environment.
• Proficient in using standard software applications, including Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).

Department

This is a non-management position

Employment Type

This is a full time position