Quality & HEDIS Outreach Specialist

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Professional Management Enterprises (PME)

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

📦 Logistics

🎖️ Defense

Healthcare • Logistics • Defense

Professional Management Enterprises (PME) is a multifaceted professional service and personnel staffing company established in 2006. As a Minority and Service Disabled Veteran Owned Business, PME operates in multiple states, partnering with major corporations such as Humana, KPMG, Ernst and Young, Anthem, and HP. The company specializes in staffing, recruiting, and providing services across various sectors, including healthcare, information technology, and administrative support. PME is a key service provider for the Department of Defense and other Federal Government clients, and it leverages its expertise in healthcare, managed care, IT, and human capital services to deliver flexible and high-performing solutions.

📋 Description

• Review and validate member lists, gaps-in-care reports, and healthcare data for outreach campaigns. • Identify members with preventive, chronic care, and other quality-related needs. • Support HEDIS, Core Set, immunization, pharmacy adherence, health needs screening, and other quality improvement initiatives. • Identify trends, inconsistencies, and opportunities in member and outreach data. • Prepare targeted outreach lists based on program and health plan priorities. • Support targeted strategies for members who are difficult to engage. • Conduct member outreach to close identified gaps in care. • Assist members with scheduling preventive, wellness, follow-up, and other healthcare appointments. • Support gap closure activities including immunizations, A1c testing, lead testing, blood pressure screenings, and telehealth appointments. • Track outreach attempts, contacts, interventions, appointments, and outcomes. • Maintain accurate and timely documentation in designated systems. • Assist with weekly, monthly, and quarterly reporting of outreach activity, campaign performance, and health outcomes. • Collaborate with BKG leadership and health plan partners to adjust priorities. • Maintain compliance with HIPAA, Medicaid requirements, approved processes, and company policies.

🎯 Requirements

• Previous experience in healthcare quality, HEDIS, population health, managed care, Medicaid, healthcare operations, or healthcare data preferred. • Experience with gaps-in-care reports, member data, healthcare reports, or quality measures preferred. • Strong Excel and data management skills. • Strong attention to detail and ability to identify trends and inconsistencies. • Ability to interpret data and translate findings into actionable next steps. • Strong organizational and analytical skills. • Strong written and verbal communication skills. • Ability to manage multiple priorities and outreach campaigns. • Experience with electronic health plan, care management, CRM, or similar systems preferred. • Knowledge of HIPAA and handling confidential healthcare information.

🏖️ Benefits

• Health, Dental, Vision • 80 hours of PTO • 10 paid holidays