Clinical Outreach Specialist

Job Description
Clinical Outreach Specialist

The Clinical Outreach Specialist, will provide clinical guidance, education, and support to patients in need of preventive and chronic care services; specifically assisting those patients with multiple co-morbidities and complex health status in order to improve health outcomes. The Clinical Outreach Specialist will perform outreach to patients in need of clinical assessment and intervention. The Clinical Outreach Specialist will assist with the development of telephone scripting for patient education. This position will also assist in the development and gathering of clinical metrics and will work with other members of the Clinical Quality team to help improve HEDIS, STARS, UDS and QARR scores for all clients of Target Health.

• Provides clinical support and guidance to approximately 8-10 nonclinical staff members (outreach coordinators). Responds to questions raised during patient outreach calls and troubleshoots/intervenes as needed.
• Conducts telephonic outreach to certain patient populations with significant health issues and/or co-morbidities to help improve access to care and the overall health status of the population.
• Advocates, informs, and educates patients on services, self-management techniques, and health benefits related to HEDIS services.
• Collaborates with providers, community-based services, and internal departments to coordinate care and assist patients with adequate access to care and services.
• Assists with the development of call scripts to address quality measures/ and patient health outcomes to drive success of outreach.
• Documents all encounters with providers, patients, and vendors in the identified system in accordance with internal and established documentation procedures and follows up as needed.
• Participates in Quality Management Program by identifying improvement opportunities related to HEDIS/QARR/STARS/UDS, including performance and thorough documentation of clinical services.
• Assists in supplying metric data for quality studies and HEDIS planning.
• Contributes to departmental and corporate goals through ongoing execution of care gap closures and associated member health outcomes improvement.
• Additional duties as assigned

Minimum Requirements

• Licensed LPN
• 2 years clinical experience
• Bilingual preferred, (English/Spanish) OR (English/Mandarin or Cantonese)
• Experience with HEDIS/Quality/QARR/STARS/UDS

Preferred Qualifications

• Licensed LPN/RN preferred with 2 years minimum clinical experience and/or 2 years minimum experience in an Outreach setting, Managed Care, Case Management, Ambulatory clinic setting, or related field
• Bachelor Arts /Bachelor Science
• Strong interpersonal and assessment skills, especially the ability to relate well with seniors, patients, and families
• Excellent verbal and written communication skills required
• Knowledge and experience with the current community health practices for the frail adult population and cognitively impaired seniors
• Experience managing patient information in a shared network environment using paperless database modules and archival systems
• Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
• Experience and knowledge of the relevant insurance types and offerings
• Previous health education or case management experience
• Ability to work independently with minimal supervision in achievement of departmental goals for engagement and productivity
• Intermediate proficiency with Microsoft Outlook, Word and Excel (including ability to edit, search, sort and filter data)

Benefits
- We offer Medical and Dental Insurance, 7 paid holidays and 1 week vacation after 90 days