Healthcare Improvement Quality Outreach Consultant

LTHC

. Act as a quality improvement liaison with physician offices, community agencies, hospitals, and members .

Posted 10/7/2026full-timeRochester • New York • United StatesMid-LevelSenior💰 $23 - $38 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality improvement initiatives, HEDIS and VBP quality measures, and effective communication with healthcare providers and community agencies. Proficient in project management and problem-solving to enhance member care and access to services.

Highest-signal resume keywords

HEDIS Quality MeasuresValue Based Payment ProgramsProject ManagementQuality Improvement PrinciplesExcellent Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality ImprovementData CollectionRoot Cause AnalysisPreventive Health ActivitiesClaims ProcessingPDSA Process Improvement CycleMember OutreachAssessment ToolsDocumentation ManagementMetrics Review

Soft Skills

Self-MotivatedConflict ResolutionMentoringCollaborationAdvocacy

Tools & Technologies

MS Office (Word, Excel, PowerPoint)IFacets

Certifications & Qualifications

LPNMedical Assistant

Industry Keywords

Health Insurance IndustryFederal and State RegulationsAccreditation StandardsNCQACMSThe Joint CommissionNYS DOHCommunity AgenciesMember PopulationsHealthcare Quality Metrics

About the role

Key responsibilities & impact

Act as a quality improvement liaison with physician offices, community agencies, hospitals, and members
Promote care management and quality programs
Identify members with gaps in care aligned with HEDIS quality measures and Value Based Payment programs
Assess member needs using approved guidelines and assessment tools and make referrals to clinical programs
Conduct telephone and written outreach and education on healthcare quality metrics
Assess barriers to care and intervene to assure access or facilitate referrals
Establish relationships with providers and community agencies and advocate for members
Address social determinants of health and provide teaching and referrals to case and disease management
Collaborate with hospital executives and physician leadership on performance, quality measures, and outcomes
Present and promote clinical programs to provider offices with Strategic Business Partners, Risk Adjustment, and Provider Relations
Educate providers and community agencies about services and programs available to Excellus members
Pilot and collect data on methods to promote quality health outcomes
Serve as a resource to healthcare improvement project teams and lead project teams as a subject matter expert
Manage caseloads, documentation, departmental metrics, provider SLAs, compliance, privacy, and attendance requirements
Level II: Prioritize work and guide junior staff through training and mentoring
Level II: Manage key provider practices and serve as point person in the Supervisor’s absence
Level II: Identify process and system problems and recommend solutions
Level II: Review metrics, apply continuous quality improvement principles, and follow the PDSA model
Level II: Research best practices and assist with new care management pilots and quality programs

Requirements

What you’ll need

Minimum of three (3) years’ experience in health/human services
Associate degree in human services or business-related field; in lieu of degree, a minimum of four years direct provider and member contact
Bachelor’s degree preferred
LPN or Medical Assistant preferred
Experience with project management
Experience working with member populations from one or more lines of business (Commercial, SafetyNet, Medicare)
Experience giving formal/informal presentations to small/large audiences
Proficiency in MS Office programs: Word, Excel, PowerPoint
Self-motivated and able to work independently as well as on matrixed teams
Ability to problem solve for effective conflict resolution
Experience with iFacets claims processing and coding preferred
Knowledge of preventive health activities and community agencies preferred
Level II: Minimum of five (5) years direct experience with the provider and member community
Level II: Excellent communication and presentation skills
Level II: Experience working with member populations from all lines of business (Commercial, SafetyNet, Medicare)
Level II: Subject Matter Expert in HEDIS and VBP quality measures
Level II: Experience and proven success with PDSA process improvement cycle
Level II: Demonstrated skills in quality principles, especially root cause analysis and problem solving
Level II: Knowledge of health insurance industry, federal and state regulations, accreditation standards, and quality improvement organizations including NCQA, CMS, The Joint Commission, and NYS DOH
Level II: Demonstrated leadership skills
Ability to travel across the health plan service regions as needed

Benefits

Comp & perks

Group health and/or dental insurance
Retirement plan
Wellness program
Paid time away from work
Paid holidays
Potential remote work, determined case-by-case
Employee development
Workforce diversity and innovative thinking culture