Clinical Quality Improvement Specialist, DentaQuest (Colorado)

Job Description

Must reside in Colorado Job description Develop member outreach and wellness initiatives that maximize goals related to 1) improvements in oral health outcomes and oral health literacy 2) network with community organizations, providers and MCO to increase oral health awareness. Preferred skills

• College degree in a related field is preferred.
• Experience working in a managed care environment is preferred.
• Knowledge of healthcare advocacy activities is preferred.
• Knowledge of the Medicaid program requirements is preferred.

Qualifications

• High School Diploma or GED required.
• 2 years job related experience
• Proficiency with Microsoft Office applications.
• Effective oral communication and business writing skills.
• Attention to detail, accuracy and organizational skills.
• Effective interpersonal skills.
• Ability to prioritize and adapt to changing priorities.
• Required to attend additional training as requested / deemed necessary
• Frequent travel up to 50% of the time
• Ability to travel long distances

Responsibilities

• Collaborate with internal teams including marketing, data science and national outreach and connect with external community groups and state agencies to develop and execute customized outreach strategies for improving oral health outcomes of enrollees.
• Implement enrollee outreach and education programs with the goal of improving oral health literacy as well as ensuring compliance l with contractual requirements.
• Develop and implement strategy to increase enrollee utilization to and achieve dental EPSDT goals as required by client contract and / or goals.
• Establish community relationships and partnerships that provide for participation in health care initiatives and programs in the dental and medical public health arena to create dental and program awareness.
• Develop educational materials and training tools in accordance with federal and state requirements for non-dental healthcare providers, managed care organizations and community organizations to engage them in the effort to educate Medicaid enrollees on the importance of oral health.
• Manage workflow, time and program interventions within budget parameters and contractual timelines.
• Provide enrollee care coordination including collaboration with Case Managers,Client Engagement and / or Provider Engagement to facilitate enrollee access tocare
• Track and monitor performance measures and report results to management and state agency if applicable.
• Independently organize, plan and source community opportunities to participate in events (health fairs, faith based organizations, schools etc) to provide enrollees with education on oral health and when feasible secure provider to conduct onsite dental screenings.
• Autonomously provide enrollees with guidance and referrals during events based on information gathered during interactions with enrollees and results of dental screening.
• Attend and plan events throughout the state based on results of EPSDT metrics, county demographics and utilization patterns.

Ensure events are distributed equally throughout the state, rural and urban areas and comply with quota and requirements of the contract.

• Represent the company in a professional manner at all times.
• Communicate to management ways to improve processes and productivity of company.
• Establish and maintain professional relationships with client and community contacts.
• Complete special projects as requested.

At Sun Life we strive to create a flexible work environment where our employees are empowered to do their best work. Several flexible work options are available and can be discussed throughout the selection process depending on the role requirements and individual needs.

For applicants residing in California, please read our employee

Job Category :

Customer Service / Operations

Posting End Date : 25 / 07 / 2024n

25 / 07 / 2024n