Quality Care Coordinator - Community Outreach

The Quality Care Coordinator - Community Outreach supports clinical and quality outcomes by assisting at Network Health Community Events and collaborating with community partners. This role involves identifying members within even service areas, conducting outreach, scheduling for gap closures, and performing medical record reviews as needed. This position contributes to the development and implementation of Population Health programs with a strong emphasis on community engagement and improving member health outcomes. The Quality Care Coordinator conducts HEDIS and year-round medical record reviews and is responsible for ensuring that Network Health meets all OCI, CMS, and NCQA quality requirements.

Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield, or a combination of both in our hybrid workplace model. Travel to community events will be required for the position.

Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday

Check out our 2024 Annual Report video to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Job Responsibilities:

• Conduct basic health checks (blood pressure, blood glucose, BMI, etc.), perform initial assessments, and identify potential health risks
• Provide health education, distribute educational materials, and give short talks or demonstrations on health-related topics for members at community events
• Assist community members in navigating local health resources, and refer individuals to mental health, housing, or food assistance programs as needed
• Provide direct outreach to members and/or providers in order to close quality gaps and maintain or exceed expected population health outcomes per HEDIS, Stars and NCQA
• Create written materials for members, physicians, and other customers in formats such as newsletters, brochures, self-care materials, educational handouts, letters, and telephone scripts
• Work with event organizers, local leaders, and other stakeholders to build trusting relationships and advocate for community members
• Responsible for development and coordination of member centric programs in alignment with industry and regulatory standards
• Evaluate utilization patterns, medical records, and other metrics to monitor quality and efficiency results
• Provide clinical support for the appeals and grievance department and quality of care complaint process, preparing cases for medical director review when needed
• Prepare and/or deliver presentations for Quality Management committee, clinic or provider education, and system-wide committees as needed
• Lead, monitor, and document quality interventions and care management programs with goal of effectiveness to promote value added care and service
• Collaborate closely with secondary providers and/or vendors to coordinate services for members
• Function as a liaison when needed for family, member, and provider to communicate any current of potential issues
• Provide recommendations for preventive services, medicine and evidence based clinical guidelines, seek approval and monitor for updates or relevant changes as assigned

Job Requirements:

• WI Registered Nurse (RN) licensure required
• Associate's degree in nursing required
• Bachelor's degree in nursing preferred
• 5 or more years of clinical experience required
• Experience in community outreach, quality improvement, HEDIS program management, medical record review, preventive care preferred
• Health plan experience preferred
• Driver's license required

Network Health is an Equal Opportunity Employer