Quality Interventions Coordinator

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 165+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.

HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care.  Interested in joining our successful Garden City Team?  We are currently seeking a Quality Interventions Coordinator! 

Position Summary: The Quality Intervention Coordinator (QIC) is the primary telephonic point of contact between HealthCare Partners and our members, providers, and pharmacies for quality improvement initiatives. Working under the direction of the Quality leadership team and in partnership with Provider Engagement, Care Management, and other internal teams, the QIC conducts high-volume outreach to close gaps in care and improve medication adherence across our Medicare, Medicaid, and Commercial lines of business. QIC spends the majority of each day communicating with members, prescriber offices, and pharmacies resolving barriers to medication adherence and gap closure, documenting every interaction accurately in our quality platforms. QIC also supports medical record retrieval activities and builds the ongoing working relationships with provider offices and pharmacies that make our outreach effective.


Essential Position Functions/Responsibilities:

Medication Adherence Outreach (primary function)

• Conduct daily outbound telephonic outreach to members identified as at risk for non-adherence to diabetes, hypertension, and cholesterol medications, and to members with other adherence-related gaps.
• Identify and resolve barriers to adherence, including cost concerns, transportation, refill timing, side effects, and confusion about the regimen; escalate clinical questions to the pharmacist team.
• Coordinate directly with retail and mail-order pharmacies to confirm fill history, resolve refill delays, transfer prescriptions, and support conversion to 90- and 100-day supplies.
• Contact prescriber offices to request refills, clarify discontinuation or changed therapy, and support prescriber-level interventions.
• Meet established daily and weekly productivity standards for completed outreach (currently 46 completed outreaches per day), and maintain accurate, timely documentation of every contact.

Gaps in Care Outreach

• Perform member outreach on open HEDIS/QARR gaps in care, educating members on the recommended service and assisting with scheduling or follow-up as needed.
• Support measure-specific campaigns (for example, breast cancer screening, colorectal cancer screening, blood pressure control, and diabetes care) as assigned by Quality leadership.
• Follow up on outreach attempts and referrals to confirm completion of services and closure of gaps.

Provider, Pharmacy, and Member Relationships

• Build and maintain positive working relationships with provider office staff, pharmacy staff, and members to support consistent, cooperative follow-through on quality initiatives.
• Serve as a reliable point of contact for provider offices with questions about gaps-in-care lists, member outreach status, and record requests.
• Partner with Provider Engagement representatives to reinforce quality messaging with practices and to escalate office-level issues.
• Communicate professionally and empathetically with members, recognizing that the member experience of these calls affects overall plan perception.

Medical Record and Documentation Support

• Support HEDIS medical record retrieval by contacting provider offices to request records, tracking outstanding requests, and following up on non-responsive offices, with volume increasing during the year-end retrieval period.
• Manage the shared Quality fax queue: monitor incoming faxes, route and index documents to the appropriate staff and systems, send outbound record requests, and confirm receipt.
• Perform accurate data entry of outreach activity and supporting documentation into quality platforms and reporting tools.

General

• Maintain working knowledge of HEDIS/QARR measure requirements relevant to assigned outreach campaigns and adherence measures.
• Proactively identify recurring barriers, member or provider trends, and process issues, and raise them to Quality leadership with suggested solutions.
• Escalate member, provider, or pharmacy issues to the appropriate management or clinical team member.
• Support and participate in quality improvement processes and initiatives.
• Other duties as assigned by leadership.

Qualification Requirements:
Skills, Knowledge, Abilities
 

• Comfort with sustained, high-volume telephonic outreach and the ability to maintain quality and professionalism across a high daily call load.
• Strong verbal communication skills, with the ability to explain clinical and pharmacy concepts clearly to members of varying health literacy.
• Superior interpersonal skills and the ability to build cooperative relationships with provider office staff, pharmacy staff, members, and colleagues across the organization.
• Strong attention to detail and accuracy in documentation and data entry.
• Strong organizational and multi-tasking skills; ability to manage a daily outreach list, a shared fax queue, and outstanding record requests simultaneously.
• Ability to work in a multidisciplinary team in a fast-paced environment with changing priorities.
• Self-starter with sound judgment about when to resolve independently and when to escalate.
• Proficiency in MS Excel, Word, and Outlook; ability to learn new quality and population health platforms quickly.
• Ability to travel within the HCP service area as needed.
• Fluency in a second language strongly preferred (Spanish, Mandarin, Arabic, Cantonese, Russian, Polish), reflecting the languages spoken by our member population.

Training/Education:
 

• Associate's degree, or an equivalent combination of education and relevant experience, required.
• Certified pharmacy technician, medical assistant, or comparable healthcare support credential, preferred.

Experience:
 

• 2 years of managed care, health plan, provider office, pharmacy, or other healthcare industry experience, required.
• Experience with high-volume members or patient telephonic outreach, preferred.
• Familiarity with Medicare Star Ratings, HEDIS/QARR requirements, and medication adherence (PDC) measures, preferred.
• Experience with pharmacy operations, prior authorization, or refill coordination, preferred.

Our website: HealthCare Partners
Base Compensation: $50,000.00- $60,000.00 annually
Bonus Incentive: Up to 12.5% annually based on organizational performance
Benefits: Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)