Quality Engagement Specialist

What you can expect! 

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Under the direction of the Manager, Regional Quality Improvement, the Quality Engagement Specialist is responsible for conducting member outreach activities to encourage healthy behaviors including awareness of needed preventive care and chronic care services, ability to navigate healthcare systems, and awareness of available community resources to meet specific needs. This position will utilize clinical systems, care management platforms, and clinical registries utilized by IEHP and network Provider partners to identify members needing outreach and support.  The Quality Engagement Specialist will act as a support resource and liaison between IEHP and network Providers to engage members in their healthcare. The Quality Engagement Specialist must effectively communicate assigned project scope, resources, and coordination status with key departments, external stakeholders, and various leadership levels. The Quality Engagement Specialist must be a proactive team player who works independently in external environments and who builds rapport with diverse members, Providers, and local community partner agencies, with a focus of engaging members into healthcare and improving their health. The Quality Engagement Specialist is responsible for supporting the Quality Improvement Department in the development, implementation, execution and monitoring of all quality initiatives, special projects, and committee deliverables as assigned. This role will require frequent travel within the Inland Empire.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary
• State of the art fitness center on-site
• Medical Insurance with Dental and Vision
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development
• Wellness programs that promote a healthy work-life balance
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

1. Serve as a dedicated resource to support Provider Network quality improvement projects supporting member engagement with Primary Care health services (i.e., supporting Provider network (or Provider office) training on member outreach best practices and Quality Measure education, making outbound calls, scheduling appointments, and completing follow-up documentation) working collaboratively with Provider office staff and IEHP project team.
2. Conduct telephonic, virtual, or face-to-face member outreach visits related to access and use of IEHP, Provider, and Community Partner programs and preventive care services, which encourage and empower members to adopt health management and healthy lifestyle behaviors.
3. Perform outreach follow up (calls, texts, emails, letters, others) to ensure all member needs have been met; outreach must follow department defined standard work (e.g., Where to identify members that require outreach, following talking points/scripts during member contacts, making the correct outreach attempts, connecting with members’ Providers for appointment scheduling, identifying Social Determinants of Health needs and connecting to resources as needed, etc.).
4. Provide education on health topics including, but limited to utilizing the healthcare system, community-based organizations, accessing care, recommended preventive health screenings, and management of chronic conditions.
5. Act as liaison between members, IEHP, Provider, and community partners to assist members with appropriate and timely access to services.
6. Act as a member advocate on issues of social support, access to care and utilization of healthcare services and resources, as needed.
7. Ensure all case documentation, results record keeping, and evaluation tools are accurate and recorded timely.
8. Identify concerns related to members’ access to care and communicate to leadership as appropriate.
9. Demonstrate a commitment to incorporate LEAN principles into daily work.
10. Establish and maintain effective working relationships with all internal stakeholders and external Provider partners.
11. Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Education & Requirements 

• At least two (2) years of experience as a CHW, Promotora, or Health Navigator, or two (2) years of experience working in community outreach, customer service, or within a medical office, or a Behavioral Health or Substance Use Disorder program required
• Applicable to Bilingual job code only - Bilingual (English/IEHP Target Language) - written and verbal skills required
• High school diploma or GED required
• Community Health Worker certification preferred

Key Qualifications

• Must have a valid California Driver’s license
• Knowledge of healthcare quality performance and measurement sets including CMS quality withhold, Managed Care Accountability Set, NCQA Quality Improvement Standards and HEDIS
• Knowledge of Medi-Cal managed care environment preferred
• Understanding of and sensitivity to multi-cultural communities
• Requires critical thinking skills
• Excellent written and verbal communication and interpersonal skills
• Strong organizational skills
• Demonstrated skills in successfully working with and engaging diverse teams
• Excellent interpersonal/communication skills
• Requires general knowledge of Microsoft Access, Word, and Excel
• Proven ability to:
  • Sufficiently engage members in a variety of settings, including on the phone, at members’ homes, in hospitals, and other settings
  • Develop relationships with community members and leaders, including in the faith-based community
  • Show a high degree of skillful decision making and judgement, in an autonomous position, including knowing when to consult with the team, supervisors, and experts
  • Develop effective relationships with Team Members, despite working primarily in the field
  • Handle multiple projects, data input, and have a strong problem-solving capability
  • Be a strong team player and proactive problem solver capable of accomplishing program goals
  • Demonstrate mature professional skills in the areas of judgment and initiative to ensure a productive work environment and achievement of quality goals
  • Maintain member confidentiality
  • Show a high degree of patience
• The Quality Engagement Specialist is an external-facing, field-based position that requires the team member to devote 80% of their time to providing monthly or as needed field engagements with assigned Providers. The frequency and nature of these engagements may be adjusted based on business needs. Performance of major duties will be carried out within off-site locations.

Start your journey towards a thriving future with IEHP and apply TODAY!

This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA.)

The Quality Engagement Specialist is an external-facing, field-based position that requires the team member to devote 80% of their time to providing monthly or as needed field engagements with assigned Providers. The frequency and nature of these engagements may be adjusted based on business needs. Performance of major duties will be carried out within off-site locations.