Quality Outreach Specialist

The Quality Outreach Specialist (QOS) plays a key role in advancing healthcare quality across Idaho by partnering with providers statewide to improve HEDIS performance and outcomes. This role facilitates collaborative plan-provider meetings focused on joint problem-solving, process enhancement, and the development of targeted initiatives to elevate care quality and member health outcomes. The QOS also works cross-functionally with internal teams to design and implement strategies that support both providers and members, ensuring alignment with organizational goals and regulatory standards.

• Experience: 3 years’ of experience in healthcare quality improvement, provider relations or provider practice operations
• Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one year college)

• Operationalize quality initiatives by translating strategic goals into actionable plans for provider networks and groups.
• Analyze performance data and provide insightful feedback and recommendations to support continuous improvement
• Design targeted interventions with clear outcomes and metrics to monitor progress toward quality goals.
• Design targeted interventions with clear outcomes and metrics to monitor progress toward quality goals.
• Support the annual HEDIS audit which may include but not be limited to, nurse abstractor education, overreading, reviewing non-compliant records to determine a more appropriate provider to request records from.
• Collaborate with internal departments to streamline data collection, processing, and reporting at the cadence needed to drive improvement.
• Initiate internal processes that support provider engagement and performance enhancement.
• Optimize workflows and systems to ensure efficiency and effectiveness in tracking and improving quality measures.
• Participate in cross-functional meetings to represent the quality team and contribute to broader organizational initiatives.
• The Quality Outreach Specialist should expect to meet with providers in-person. Expected travel approximately 20%.
• Support additional quality-related tasks as needed to meet evolving priorities

As of the date of this posting, a good faith estimate of the current pay range is $76,346 to $114,518. The position is eligible for an annual incentive bonus (variable depending on company and employee performance).

The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.