Quality Outcomes Associate

Position Summary

The Quality Outcomes Associate (QOA) will support high-impact Population Health programs by performing provider and member outreach, education and engagement, medical record abstraction and data entry to support continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) rates, including Medicare Stars and Medicaid QARR. As HCP's external facing quality liaison, the QOA will report directly to the CEC to ensure all external communication and branding efforts align with HCP's corporate messaging by working in partnership with the Network Relations and Customer Engagement Center teams'. The QOA will also facilitate provider and member outreach to ensure members receive important clinical intervention services to improve their overall health outcome. This role will also support the efficient medical record retrieval for HEDIS medical record review and HEDIS supplemental data collection activities.

Responsibilities

• Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
• Consistently performs communication strategies that align with all external facing roles within Network Relations and the Customer Engagement Center.
• Understands HCP's brand recognition and communication efforts.
• Makes outbound calls to members to provide reminders, guidance and assistance in obtaining services to avoid delays in treatment and improve health outcomes.
• Collaborates with Provider Relations Specialists and Network Relations Consultants to ensure provider quality metrics are accurately explained and achieved.
• Serves as the quality resource for any external questions raised by providers and/or field specialists.
• Supports the Network Relations team on provider education and implementation of certain quality programs through improvement interventions.
• Develops and distributes educational information to members and providers in accordance with the HEDIS and Population Health work plans.
• Assists in the development and standardization of outreach documentation and manages the data flow process to complete HEDIS documentation.
• Documents member participation in outreach activities in accordance with abstraction and audit standards.
• Conducts HEDIS provider chart request calls and mailings.
• Contributes and maintains member incentive programs to support HEDIS initiatives.
• Records and documents all member and provider outreach activity.
• Support Population Health programs and performs other duties as required.

Qualifications

• Demonstrates ability to give close attention to details for accuracy, including planning, executing, and follow up procedures.
• Strong communication skills and experience speaking with medical providers.
• Ability to multitask and work independently.

Education

• Associate's degree, or combination of education and experience, required.
• Bachelor's degree in health care related field, preferred.

Experience

• Minimum 1 year experience with Healthcare Effectiveness Data and Information Set (HEDIS) data collection and quality improvement activities.
• Minimum 3 years' recent experience working in a health care setting (e.g. managed care, provider office, hospital, clinic, pharmacy, etc.).
• Experience working in a professional, corporate office setting.
• Ability to use standard software packages and Microsoft Office Suite Applications: (Outlook, Work, Excel, PowerPoint, etc.)