Quality Specialist

Company Name:
Riverside Health, Inc.
Position Type:
Position Summary:

The Quality Specialist follows established preventive and disease management programs for health promotion and education. This position delivers culturally appropriate information regarding the availability of health and community resources that will reduce barriers to care.
Essential Duties and Responsibilities

Curriculum and planning for member and provider health education activities
Manage the Riverside Outreach Plan to assist enrollees in overcoming barriers in accessing health care services.
Identify the populations in need of education and outreach and make modifications as appropriate.
Promote health, wellness, prevention, and Community Health
Collaborate with educational and outreach efforts that includes case management, disease management, PCP referral for a one-on-one intervention for the member with complex medical needs, the home bound, and the noncompliant member with health issues.
Facilitate access to care
Manage difficult to reach and non-compliant members
Communicate member issues requiring interventions to appropriate departments and providers
Develop and maintain a report system, updating tracking logs, for outcomes that includes accurate data pertaining to the member's health needs
Organize, collect, and create quantitative/qualitative analysis reporting to internal works groups, quality committees, network providers, and community liaisons.
Collect and report health and social information while demonstrating multicultural sensitivity and effective communication skills with Medicaid members
Adhere to regulatory and accreditation support
Perform other duties as assigned
Education, Experience and Qualifications

Associates, Bachelor's degree in a related field or designation from the Academy of Healthcare Management (AHM)
Strong electronic, written, and verbal communication skills
Ability to work flex hours, including an occasional evening and weekend
Possess a valid Maryland State driver's license
Strongly preferred:

2+ years of experience in managed care, community, human services, nursing, and/or other health care settings.
Experience working with diverse populations, community or faith based organizations
Bilingual (English / Spanish)

Knowledge, Skills and Abilities

Knowledge of health education, motivational strategies, and an empathetic manner working with the underserved.
Knowledge of Maryland Medicaid healthcare business preferred.
Excellent verbal and written communication skills, including conflict resolution skills.
Strong organizational and follow up skills; specifically working with Inner City, Suburban and Rural neighborhood members.
Ability to collect and report outcomes verbally and in writing.
Ability to maintain confidentiality and assume accountability.
Proven ability to work in a self-directed manner, off-site with minimum supervision or field support
Instructional methods in Health Education and Outreach
Organization, Implementation and Management of Health Education and Outreach Programs
Measurement and Evaluation Curriculum and Planning for member and provider outreach and health education
Chronic and communicable Disease
Organizational Communications
Ability to meet deadlines in a consistent manner
Strong written and verbal skills
Knowledge of Medicaid and Medicare benefits desirable
Computer Skills

Microsoft Office skills to include Word, Excel, Access, PowerPoint, Project and SharePoint
Familiar with data entry systems (e.g., electronic medical records/electronic health records)
Company Description:
Riverside Health is a new kind of health plan. We believe that good care depends on working closely with our members and their doctors to provide the best possible care. We promote strong doctor-patient relationships through supportive care management strategies and innovative technology. We work in partnership with our health care providers by getting rid of administrative hassles that can be barriers to good patient care. We work closely with our local partners because we understand that all health care is local.

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