Offer summary

Qualifications:

Associates degree in healthcare or equivalent work experience (3 years) required., 2 years of experience in case management or health insurance environment needed., Minimum of 2 years working with members to close care gaps is essential., Knowledge of medical terminology and managed care practices is required..

Key responsibilities:

Conduct clinical outreach calls and handle inbound calls related to quality initiatives.

Educate members on closing care gaps and provide health education materials.

Maintain accurate records of member interactions and issues.

Act as a liaison between members, providers, and community resources to facilitate care.

Job description

Our Client, a Health Insurance company, is looking for a Quality Outreach Coordinator I for their Remote location.

Responsibilities:

This position will conduct clinical member outreach calls as well as take inbound calls as it relates to all Quality Outreach Initiatives. This position will focus on members with HEDIS and Star care gaps that are high risk for non-compliance and will assist the member in eliminating barriers and close care gaps.
Receives incoming calls from members emanating from quality outreach initiatives such as mailings, emails, phone calls, etc.
Makes outgoing calls to educate members on the importance of closing gaps in care such as appropriate testing, periodical checkups, immunizations, counseling and provide health education materials.
Maintain accurate member records from outreaches such as incoming calls, successful outreaches, member issues, and member roadblocks.
Act as a liaison with providers, members and outside community resources by assisting with scheduling an appointment, warm transfers to member services, etc.
Assure understanding level of each member by providing clear and complete information in accordance with company guidelines.
Administer Rewards and Incentive programs for both Medicaid and Medicare members by sending out rewards, confirm member demographics, and educate members in regards to the R&I Program.
Refer members to a Clinical Quality nurses as necessary.
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position.
This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

Requirements:

Requires an Associates degree from an accredited college or university, preferably in healthcare field. In lieu of degree applicant must have 3 years of equivalent and relevant work experience.
Requires 2 years work experience in case management, community health, Medicaid or health insurance environment.
Requires a minimum of 2 years experience working with members to close gaps in care.
Requires a minimum of 1 year managed care experience.
Requires knowledge of the Managed Care or Health Insurance Industry.
Requires knowledge of medical terminology.
Requires knowledge of PC's and windows based software applications.
Prefer knowledge of Medicaid and Medicare regulations.

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.

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