Quality/HEDIS Coordinator (Member Outreach)

Position Purpose:
The purpose of this position is to support the health plan’s quality and performance goals, with a focus on achieving a 5-star rating for medication adherence measures. This includes conducting outbound calls to members to close HEDIS gaps in care, discussing the importance of medication adherence, contacting provider offices to obtain prescriptions, and working with pharmacies to facilitate prescription refills and resolve medication access issues. The role will also require ongoing communication and collaboration with the Pharmacy Department, Provider Relations, and any vendors contracted by the plan to support medication adherence efforts.

Key Responsibilities:

• Conduct outbound calls to members to encourage medication adherence, support prescription refills, and close HEDIS gaps in care.
• Educate members on the importance of taking medications as prescribed, while identifying and addressing any barriers.
• Contact provider offices to obtain prescriptions and clarify medication regimens.
• Contact pharmacies to verify prescription status, resolve access issues, and facilitate timely medication fulfillment.
• Communicate and collaborate regularly with internal teams, including Pharmacy and Provider Relations, as well as external vendors such as PBMs or adherence support partners.
• Assist with basic data analysis, including organizing and interpreting medication adherence data to help guide outreach strategies and inform internal and vendor teams.
• Document all member and provider interactions accurately in designated systems and escalate issues as needed.
• Monitor outreach outcomes and support continuous improvement in adherence initiatives.
• Maintain confidentiality and comply with HIPAA and organizational policies.

Qualifications:

• Minimum of 2+ years of experience in a healthcare setting, with a focus on patient outreach, customer service or care coordination is required.
• Experience with member or patient outreach, customer service, or care coordination strongly preferred.
• Knowledge of HEDIS measures, Medicare/Medicaid quality programs and mediation adherence is preferred.
• Understanding of medication adherence concepts and familiarity with pharmacy operations is a plus.
• Excellent verbal communication and interpersonal skills, with the ability to educate, motivate, and problem-solve over the phone.
• Comfortable making high-volume outbound calls to members, providers, and pharmacies.
• Proficient in Microsoft Office, specifically Excel and experienced with healthcare data systems or EMRs.
• Basic analytical skills, including experience working with spreadsheets (Excel or similar), and the ability to interpret and organize data effectively.
• Strong attention to detail, time management, and the ability to work both independently and as part of a cross-functional team.
• Commitment to maintaining confidentiality and complying with HIPAA and organizational standards.
• Bilingual in English/Spanish is required.

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.