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Children-s Medical Outreach Specialist

Company: Healthfirst
Location: New York
Posted on: November 11, 2019

Job Description:

Quality will provide clinical guidance and support to the Clinical Outreach team, specifically assisting with those members with multiple co-morbidities and complex health status. The Outreach Specialist will also assist with development of telephone scripts for barrier analyses, and conduct barrier analysis calls as indicated. This position will also assist in the development and gathering of clinical metrics for the unit, and will work with other members of the Clinical Performance Management team to help improve HEDIS and QARR scores for both Medicare and Medicaid populations. * Provides clinical support and guidance to approximately 8-10 staff members (outreach coordinators). Responds to questions raised during member outreach calls and troubleshoots/intervenes as needed. * Conducts telephonic outreach to certain member populations with significant health issues and/or co-morbidities, in order to help improve access to care and the overall rates of required services. * Assists with the development of barrier analysis call scripts to address measures/conditions where HEDIS/QARR/STARS rates are not as expected. Conducts barrier analysis calls to specific member populations to determine any systemic reasons for low performance. Assists in the development of interventions to address identified barriers. * Participates in Quality Management Program by identifying improvement opportunities related to HEDIS/QARR/STARS, including performance and through documentation of clinical services. Assists in supplying metric data for quality studies and HEDIS planning. * Provide support and guidance to up to five coordinators focusing on pregnant members. * Additional duties as assigned * Registered Nurse with minimum of three years general medical experience in a physician office, ambulatory, acute or long term care setting, or a managed care setting. * Outreach or quality experience. * Familiarity with HEDIS/QARR specifications. * Previous health education or case management experience, especially in Obstetric health education or case management. * Ability to work independently with minimal supervision. * Excellent interpersonal and communication skills. * Bilingual (English/Spanish or English/Chinese Mandarin or Cantonese * Intermediate proficiency with Microsoft Outlook, Excel, Word - Previous work experience with direct member contact or education. WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to *********************** or calling ************ . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services. EEO Law Poster and Supplement

Keywords: Healthfirst, New York , Children-s Medical Outreach Specialist, Healthcare , New York, New York

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