Quality & HEDIS Outreach Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Review and verify member lists, gaps-in-care reports, and healthcare data for outreach initiatives.

• Identify members requiring preventive care, chronic care, and other quality-related services.

• Assist with HEDIS, Core Set, immunization, pharmacy adherence, health needs screenings, and various quality improvement projects.

• Analyze trends, inconsistencies, and opportunities within member and outreach data.

• Create targeted outreach lists aligned with program and health plan objectives.

• Develop strategies for engaging members who are challenging to reach.

• Conduct outreach to members to address identified gaps in care.

• Help members schedule preventive, wellness, follow-up, and other necessary healthcare appointments.

• Facilitate gap closure efforts including immunizations, A1c testing, lead testing, blood pressure screenings, and telehealth sessions.

• Monitor outreach attempts, contacts, interventions, appointments, and outcomes.

• Ensure accurate and timely documentation in designated systems.

• Support the preparation of weekly, monthly, and quarterly reports on outreach activities, campaign performance, and health outcomes.

• Collaborate with BKG leadership and health plan partners to realign priorities as needed.

• Uphold compliance with HIPAA, Medicaid regulations, established processes, and company policies.

⛳️ Requirements

• Prior experience in healthcare quality, HEDIS, population health, managed care, Medicaid, healthcare operations, or healthcare data is preferred.

• Familiarity with gaps-in-care reports, member data, healthcare reports, or quality measures is preferred.

• Proficient in Excel and data management.

• Detail-oriented with a keen ability to identify trends and inconsistencies.

• Capable of interpreting data and converting findings into actionable steps.

• Strong organizational and analytical capabilities.

• Excellent written and verbal communication skills.

• Ability to juggle multiple priorities and outreach campaigns effectively.

• Experience with electronic health plans, care management, CRM, or similar systems is preferred.

• Knowledgeable about HIPAA regulations and the handling of confidential healthcare information.

🏝️ Benefits

• Health, Dental, Vision

• 80 hours of PTO

• 10 paid holidays