Quality Improvement Outreach Specialist

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Quality Improvement Outreach Specialist supports quality improvement initiatives through member-focused outreach and engagement focused on closing quality gaps in care and improving health outcomes. This role conducts proactive outreach to members for all lines of business to encourage completion of recommended preventive screenings and chronic care services. As a key member of the Quality team, this position plays a vital role in improving HEDIS, Stars and other quality measure performance and advancing overall member health through culturally competent education, coordination, and engagement.

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/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

Qualifications:
Education Required:

·       Associate degree in nursing or post high school nursing diploma

Education Preferred:

·       Bachelor’s or Master’s Degree in healthcare or related field

Experience Required:

·       2 years of experience as a practicing nurse in a hospital/healthcare setting or performing direct member outreach

Experience Preferred/Desirable:

·       2+ years of experience in health insurance field

·       2+ years of experience in quality improvement

Required Licensure, Certification or Conditions of Employment:

·       Successful completion of pre-employment background check

Competencies, Skills, and Attributes:
Required :

·       Strong proficiency in use of office equipment including copier, fax machine, scanner, and telephones

·       Strong PC proficiency in word processing, spreadsheet, and database software

Preferred:

·       Advanced PC proficiency

Professional Competencies:
Required:

·       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

Compensation Range 

$74,000 - $107,000

This range offers an estimate based on the minimum job qualifications.  However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.  

Note: This range is based on Boston-area data, and is subject to modification based on geographic location. 

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees