Quality Outreach Coordinator

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

This position will conduct clinical member outreach calls as well as take inbound calls as it relates to all Quality Outreach Initiatives. This positon will focus on members with HEDIS and Star care gaps that are high risk for non-compliance and will assist the member in eliminating barriers and close care gaps.Responsibilities:

• Receives incoming calls from members emanating from quality outreach initiatives such as mailings, emails, phone calls, etc.

• Makes outgoing calls to educate members on the importance of closing gaps in care such as appropriate testing, periodical checkups, immunizations, counseling and provide health education materials.

• Maintain accurate member records from outreaches such as incoming calls, successful outreaches, member issues, and member roadblocks.

• Act as a liaison with providers, members and outside community resources by assisting with scheduling an appointment, warm transfers to member services, etc.

• Assure understanding level of each member by providing clear and complete information in accordance with company guidelines.

• Administer Rewards and Incentive programs for both Medicaid and Medicare members by sending out rewards, confirm member demographics, and educate members in regards to the R&I Program.

• Refer members to a Clinical Quality nurses as necessary.

Disclaimer:

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Education/Experience:

• High School Diploma/GED required.

• Requires 3 years of equivalent and relevant work experience.

• Requires 2 years work experience in case management, community health, Medicaid or health insurance environment.

• Requires a minimum of 2 years experience working with members to close gaps in care.

• Requires a minimum of 1 year managed care experience.

Knowledge:

• Requires knowledge of the Managed Care or Health Insurance Industry.

• Requires knowledge of medical terminology.

• Requires knowledge of PC's and windows based software applications.

• Prefer knowledge of Medicaid and Medicare regulations.

Skills and Abilities:

• Requires excellent verbal and written communication skills.

• Requires excellent service quality skills.

• Requires excellent organizational and interpersonal skills.

• Requires good decision making skills.

• Requires good problem solving/conflict resolution skills.

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); Should be knowledgeable in the use of intranet and internet applications.

Salary Range:

$61,200 - $81,900

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.