Express Scripts Jobs in California (NOW HIRING)

FLSA Status:Non-Exempt
Department:Quality Improvement
Reports To:Manager, Quality & Health Education

Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521

The Quality Outreach Coordinator provides support for Quality Improvement activities and programs to contribute to the effectiveness and efficiency of the department. The Quality Outreach Coordinator will assist departmental programs and initiatives such as Quality Improvement and Management, Cultural and Linguistics, Health Education and NCQA activities.

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Conduct outreach calls to members to assist in obtaining services (i.e. provide reminders, make appointments, educate through script) to address quality care gaps and to administer surveys related to quality of care and service.
2. Track and report on outcomes of outreach activities.
3. Coordinate clinic day activities and other events, which may be outside of normal office hours, with provider offices and clinics including distribution of member incentives and appointment scheduling.
4. Contribute to developing and coordinating outreach desktop procedures, mailing materials, and call scripts in accordance with the quality outreach work plan.
5. Provide administrative support to HEDIS activities to achieve quality goals, including but not limited to: retrieve medical records, remote and/or onsite provider office data collection, formulate and compile monthly reports, and communicate with contracted vendors.
6. Support and monitor Health Education activities through tracking and reporting referral and utilization of classes by members from various vendors, sources and channels.
7. Support and monitor Cultural Linguistics activities through tracking and reporting utilization of translation and interpretation services internally and by providers and members.
8. Assist in developing quality interventions to improve member health outcomes and achieve SCFHP goals, key performance index and regulatory requirements.
9. Ensure compliance with applicable regulatory and reporting requirements; monitor new requirements and update required documents accordingly.
10. Attend and actively participate in weekly, monthly and as needed departmental meetings, training and coaching sessions.
11. Perform other related duties as required or assigned.

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. Associate's Degree in a related field of study, or equivalent training/experience. (R)
2. Minimum one year of experience working in a healthcare setting supporting QI and/or other related healthcare programs. (R)
3. 1 year of experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations. (D)
4. 1 year of experience with HEDIS. (D)
5. Bilingual in Spanish or Vietnamese. (D)
6. Proficient in adapting to changing situations and efficiently alternating focus between telephone and non-telephone to fulfill business needs. (R)
7. Ability to pay attention to detail and work accurately. (R)
8. Ability to form positive, professional relationships with internal and external stakeholders. (R)
9. Possess and maintain a valid, current California Driver's License. (R)
10. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R)
11. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
12. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members and providers over the telephone, in person or in writing. (R)
13. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
14. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
15. Ability to maintain confidentiality. (R)
16. Ability to comply with all SCFHP policies and procedures. (R)
17. Ability to perform the job safely with respect to others, to property, and to individual safety. (R)

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. Reasoning Requirements: ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday

General office conditions. May be exposed to moderate noise levels.