WellSense Health Plan · 6 hours ago
Quality Improvement Outreach Specialist
United States
Full-time
Remote
Entry, Mid Level
$74K/yr - $107K/yr
2+ years expWellSense Health Plan is a growing regional health insurance company dedicated to providing health insurance that works for its members. The Quality Improvement Outreach Specialist supports quality improvement initiatives through member-focused outreach and engagement, aiming to close quality gaps in care and improve health outcomes.
Hospital & Health Care
No H1B
Responsibilities
Perform outreach calls to members with quality gaps in care
Provide education, motivational support, and scheduling assistance to help close identified care gaps and improve quality outcomes
Follow up with members requiring support in taking steps to close care gaps
Document outreach activities, tracks progress and results and supports reporting for quality campaign and initiatives
Evaluate Health Related Social Needs that may impact the member’s ability to access needed services
Collaborate with internal teams to ensure coordinated member support
Meet quality and timeliness standards to achieve individual and departmental performance goals
Maintain current knowledge of quality measures and best practices
Ensure compliance with all state and federal regulations for activities performed
Participate in quality improvement activities and cross-department meetings, supporting discussions and reporting as needed
Develop and maintain policies & standard operating procedures of processes to maintain compliance
Support programs and clinical best practices with the objective of improving health outcomes, preventing hospital readmissions, and promoting health and wellness activities
Other duties as assigned
Qualification
Required
Associate degree in nursing or post high school nursing diploma
2 years of experience as a practicing nurse in a hospital/healthcare setting or performing direct member outreach
Successful completion of pre-employment background check
Strong proficiency in use of office equipment including copier, fax machine, scanner, and telephones
Strong PC proficiency in word processing, spreadsheet, and database software
Effective collaborative and proven process improvement skills
Strong oral and written communication skills; ability to interact within all levels of the organization
Demonstrated commitment to excellent customer service
Knowledge and understanding of current trends in healthcare
Aptitude for aligning process, projects, and people to meet business goals in cross-functional team settings
Health care payer business knowledge including processes and operational data and functions that support the business
Maintain confidentiality and privacy
Capable of investigative and analytical research to make decisions and recommendations based on available information
Independent and sound judgment with good critical thinking skills
Knowledge of managed care, utilization management, and quality management
Establish and maintain working relationships with health care providers, members, and coworkers
Practice interpersonal and active listening skills to achieve customer satisfaction and departmental communication standards
Ability to Interpret policies, programs, and guidelines
Establish and maintain working relationships in a collaborative team environment
Organizational skills with the ability to prioritize tasks and work with multiple priorities
Maintains current knowledge of State, Federal and other applicable regulatory/accrediting agency requirements as they apply to department functions
Preferred
Bachelor's or Master's Degree in healthcare or related field
2+ years of experience in health insurance field
2+ years of experience in quality improvement
Advanced PC proficiency
Benefits
Medical
Dental
Vision
Pharmacy
Merit increases
Flexible Spending Accounts
403(b) savings matches
Paid time off
Career advancement opportunities
Resources to support employee and family wellbeing
Company
WellSense Health Plan
A nonprofit health plan serving Medicare, Individual & Family, and Medicaid plan members in Massachusetts & New Hampshire.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Heather Thiltgen
President & CEO
Diana Cruz
Chief Operating Officer
Company data provided by crunchbase