Case Management Quality Outreach Specialist III

Medica's Case Management Quality Outreach Specialist III assists in conducting targeted outreach to support our membership in achieving and maintaining optimal health. This individual will play a critical role in ensuring high quality healthcare for our members. This is a highly collaborative role that is positioned to support Medica's Case Management and Quality teams. This role will be aligned under Case Management with our Engagement team and will work closely alongside the Case Management team to support quality initiatives.

A successful Quality Outreach Specialist will be skilled at telephonic work, including navigation of the health plan and community providers and facilities. This includes having exceptional skills in organization, prioritization, problem solving, and autonomy. Interpersonal and external provider/care system relationship skills are essential. Maintaining a strong working knowledge of numerous Medica sponsored and external health programs and services is also required.

Our Quality Outreach Specialist will be responsible for leading telephonic outreach to members and providers for triage and steerage, driving targeted engagement and participation with quality outreach campaigns. The role will support the organization's quality improvement initiatives, enhance member outcomes, and improve coordination of services. This will be achieved through primarily outbound calls to identified members to provide education and assistance with access to care. This may also include making real-time (non-clinical) screening as to the most appropriate intervention for identified members. Additional responsibilities to include securing medical records from external providers and facilities to support quality standards with intent to close care gaps.

Qualifications:

• High School diploma, equivalent combination of education and work experience (bachelor's degree preferred)
• 3+ years' experience in a member-facing telephonic engagement and/or service support role
• Experience in a customer service, call center, managed care or health care related environment strongly preferred
• Experience collaborating with providers and other health professionals preferred
• Familiarity and understanding of healthcare quality improvement standards and principles including HEDIS, Gaps in Care, Stars, and the impact from a health plan perspective

Skills and Abilities:

• Demonstrated autonomy, initiative in handling work, strong analytical and problem-solving skills to proactively assess project needs and barriers and initiate solutions




• Self-starter, independent functioning with strong organizational and communication skills
• Ability to effectively facilitate phone conversations to engage members in prevention and medical management initiatives by scheduling and conducting outreach to selected populations, tracking of outreach efforts and providing reports on outcomes
• Excellent communication and interpersonal skills with the ability to effectively engage and collaborate with diverse stakeholders
• At ease working with various populations: multiple age groups, vulnerable and complex populations, and diverse ethnic and socioeconomic backgrounds, including seniors and those with disabilities
• Advanced computer skills and application knowledge specifically Microsoft Office applications, with ability to master multiple computer programs and documentation platforms
• Attention to detail and accuracy a must




• Ability to seamlessly adjust projects based on department priorities and to manage multiple projects at one time
• Assist and participate in meeting company and department goals inclusive of quality improvement activities
• Promote timely and effective communication
• Perform other duties as assigned

This position is a Hub role, which requires an employee to occasionally come onsite to the designated office for applicable heads-up work. Frequency is determined by business need as decided by leadership.

The full salary range for this position is $44,900 - $77,000. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.