Healthcare Improvement Quality Outreach Consultant

This is a fully remote position, open to applicants in New York.

📋 Description

• Identify members with care gaps utilizing various information sources, HEDIS quality measures, and Value-Based Payment programs.

• Evaluate member needs using Health Plan-approved guidelines and assessment tools.

• Conduct outreach and education via telephone and written communication regarding healthcare quality metrics.

• Identify barriers to care and facilitate access, referrals, and interventions.

• Build relationships with providers and community organizations.

• Advocate for members while addressing social determinants of health.

• Collaborate with hospital executives and physician leadership on quality measures and outcomes.

• Present and promote clinical programs to provider offices, educating providers and community organizations.

• Pilot initiatives and gather data on strategies to enhance health outcomes.

• Serve as a resource for healthcare improvement project teams and lead these teams as a subject matter expert.

• Manage caseloads and maintain documentation in accordance with health plan standards.

• Achieve departmental metrics such as call volumes, reach rates, and gap closure rates.

• Ensure compliance with provider Service Level Agreements.

• Follow compliance, regulatory, privacy, and corporate conduct standards.

• Level II: Prioritize tasks and provide guidance, training, and mentorship to junior staff.

• Level II: Manage key provider practices and act as the point of contact in the Supervisor’s absence.

• Level II: Collaborate across departments to enhance processes and systems.

• Level II: Review metrics and apply continuous quality improvement principles.

• Level II: Utilize the PDSA model to assess practice outcomes, identify best practices, and suggest improvements.

• Level II: Research best practices across health plans and trends in healthcare improvement.

• Level II: Assist in the development and implementation of innovative care management pilots and quality programs.

⛳️ Requirements

• Minimum of three (3) years of experience in health/human services.

• Associate degree in human services or a business-related field, or a minimum of four years of direct provider and member contact in lieu of a degree.

• Bachelor’s degree preferred.

• LPN or Medical Assistant certification preferred.

• Experience in project management.

• Experience working with member populations from one or more lines of business (Commercial, SafetyNet, Medicare).

• Experience delivering formal and informal presentations to small and large audiences.

• Proficient in MS Office programs: Word, Excel, PowerPoint.

• Self-motivated and capable of working independently as well as collaboratively in matrixed teams.

• Strong problem-solving skills for effective conflict resolution.

• Experience with iFacets claims processing and coding is preferred.

• Familiarity with preventive health activities and community agencies is preferred.

• Level II: Minimum of five (5) years of direct experience with the provider and member community.

• Level II: Excellent communication and presentation skills.

• Level II: Experience working with member populations across all lines of business (Commercial, SafetyNet, Medicare).

• Level II: Subject Matter Expert in HEDIS and VBP quality measures.

• Level II: Proven success with the PDSA process improvement cycle.

• Level II: Demonstrated skills in quality principles, particularly in root cause analysis and problem-solving.

• Level II: Knowledge of the health insurance industry, federal and state regulations, accreditation standards, and quality improvement organizations including NCQA, CMS, The Joint Commission, and NYS DOH.

• Level II: Demonstrated leadership abilities.

• Willingness to travel across the health plan service regions as needed.

🏝️ Benefits

• Group health and/or dental insurance.

• Retirement plan.

• Wellness program.

• Paid time off.

• Paid holidays.

• Potential for remote work, evaluated on a case-by-case basis.

• Employee development opportunities.

• Competitive compensation.

• A culture that values workforce diversity and innovative thinking.