Quality Outcomes Associate

Position Summary:
The Quality Outcomes Associate (QOA) plays a key role in supporting high-impact Population Health programs through provider and member outreach, education, and engagement. This position is essential to driving continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) measures, including Medicare Stars and Medicaid QARR.
As the external-facing quality liaison for HCP, the QOA ensures all communications align with HCP’s corporate messaging and branding by working in close partnership with the Customer Engagement Center (CEC), Pharmacy, Risk Adjustment, Utilization Management, Quality, Network Relations, and other internal teams.
Core responsibilities include:

• Facilitating provider and member outreach to promote timely clinical interventions that improve health outcomes.
• Supporting medical record abstraction, retrieval, and data entry for HEDIS medical record review and supplemental data collection.
• Acting as a quality ambassador in external engagements, ensuring consistency in communication and alignment with strategic goals.

This role is instrumental in bridging internal quality initiatives with external provider and member engagement, ultimately contributing to improved performance metrics and member health outcomes.

Essential Position Functions/Responsibilities:

• Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
• Consistently supports communication strategies aligned with the external-facing roles of Network Relations and the Customer Engagement Center (CEC).
• Maintains a strong understanding of HCP’s brand recognition and communication efforts.
• Conducts outbound calls to members to provide reminders, guidance, and assistance in obtaining services to avoid delays in care and support improved health outcomes.
• Collaborates with internal teams to ensure accurate understanding and achievement of quality and risk adjustment metrics.
• Serves as a quality resource for providers and field specialists, addressing questions and offering guidance on quality initiatives.
• Supports internal teams in educating providers and implementing quality and risk adjustment programs through targeted interventions.
• Distributes educational materials to providers and members in accordance with HEDIS and Population Health work plans.
• Assists in the development and standardization of outreach documentation and manages data flow processes to support HEDIS documentation requirements.
• Accurately documents member participation in outreach activities in line with abstraction and audit standards.
• Conducts HEDIS chart request outreach to providers via calls and mailings.

• Supports the implementation and tracking of member incentive programs related to HEDIS measures.
• Records and maintains detailed documentation of all outreach activities with members and providers.
• Supports Population Health programs and performs additional duties as assigned.
• Assists with CAHPS-related outreach calls as needed.

Qualification Requirements:
Skills, Knowledge, Abilities

• Strong attention to detail, with the ability to plan, execute, and follow up on tasks accurately and efficiently.
• Excellent verbal and written communication skills, including experience engaging with medical providers in a professional manner.
• Proven ability to multitask, prioritize responsibilities, and work independently in a fast-paced environment.

Training/Education:

• Associate’s degree or an equivalent combination of education and relevant experience is required.
• Bachelor’s degree in a healthcare-related field is preferred.

Experience:

• Minimum of 1 year of experience with Healthcare Effectiveness Data and Information Set (HEDIS) data collection and quality improvement activities.
• At least 3 years of recent experience in a healthcare setting (e.g., managed care organization, provider office, hospital, clinic, or pharmacy).
• Experience working in a professional, corporate office environment.
• Proficient in using standard software applications, including Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.

Position Summary:
The Quality Outcomes Associate (QOA) plays a key role in supporting high-impact Population Health programs through provider and member outreach, education, and engagement. This position is essential to driving continuous quality improvement in Healthcare Effectiveness Data and Information Set (HEDIS) measures, including Medicare Stars and Medicaid QARR.
As the external-facing quality liaison for HCP, the QOA ensures all communications align with HCP’s corporate messaging and branding by working in close partnership with the Customer Engagement Center (CEC), Pharmacy, Risk Adjustment, Utilization Management, Quality, Network Relations, and other internal teams.
Core responsibilities include:

• Facilitating provider and member outreach to promote timely clinical interventions that improve health outcomes.
• Supporting medical record abstraction, retrieval, and data entry for HEDIS medical record review and supplemental data collection.
• Acting as a quality ambassador in external engagements, ensuring consistency in communication and alignment with strategic goals.

This role is instrumental in bridging internal quality initiatives with external provider and member engagement, ultimately contributing to improved performance metrics and member health outcomes.

Essential Position Functions/Responsibilities:

• Identifies potential resources and initiates collaboration with providers to improve member health outcomes and HEDIS measures.
• Consistently supports communication strategies aligned with the external-facing roles of Network Relations and the Customer Engagement Center (CEC).
• Maintains a strong understanding of HCP’s brand recognition and communication efforts.
• Conducts outbound calls to members to provide reminders, guidance, and assistance in obtaining services to avoid delays in care and support improved health outcomes.
• Collaborates with internal teams to ensure accurate understanding and achievement of quality and risk adjustment metrics.
• Serves as a quality resource for providers and field specialists, addressing questions and offering guidance on quality initiatives.
• Supports internal teams in educating providers and implementing quality and risk adjustment programs through targeted interventions.
• Distributes educational materials to providers and members in accordance with HEDIS and Population Health work plans.
• Assists in the development and standardization of outreach documentation and manages data flow processes to support HEDIS documentation requirements.
• Accurately documents member participation in outreach activities in line with abstraction and audit standards.
• Conducts HEDIS chart request outreach to providers via calls and mailings.

• Supports the implementation and tracking of member incentive programs related to HEDIS measures.
• Records and maintains detailed documentation of all outreach activities with members and providers.
• Supports Population Health programs and performs additional duties as assigned.
• Assists with CAHPS-related outreach calls as needed.

Qualification Requirements:
Skills, Knowledge, Abilities

• Strong attention to detail, with the ability to plan, execute, and follow up on tasks accurately and efficiently.
• Excellent verbal and written communication skills, including experience engaging with medical providers in a professional manner.
• Proven ability to multitask, prioritize responsibilities, and work independently in a fast-paced environment.

Training/Education:

• Associate’s degree or an equivalent combination of education and relevant experience is required.
• Bachelor’s degree in a healthcare-related field is preferred.

Experience:

• Minimum of 1 year of experience with Healthcare Effectiveness Data and Information Set (HEDIS) data collection and quality improvement activities.
• At least 3 years of recent experience in a healthcare setting (e.g., managed care organization, provider office, hospital, clinic, or pharmacy).
• Experience working in a professional, corporate office environment.
• Proficient in using standard software applications, including Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.