At Shire, we are proud and grateful to employ military veterans and thank them for their contributions to our company and our country. See where your military experience can play a role at Shire by using our military skills translator job search tool below:
JOB REQUIREMENTS: Description 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... For full info follow application link. Equal Opportunity Employer including Veterans and Disabled Individuals ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/79D72AB6F9B94637