Job Description

Job Description

Job Title: Outreach Specialist – Quality & Member Engagement

Job Summary

The Outreach Specialist supports Quality Management and Care Coordination initiatives by engaging members through outreach efforts, administering Health Risk Assessments (HRA), identifying care needs, and connecting members to appropriate clinical and social services. This role plays a critical part in improving member outcomes, quality performance, and overall satisfaction through effective communication, accurate documentation, and coordinated follow-up.

Key Responsibilities

• Conduct outbound and inbound outreach to members to administer Health Risk Assessments (HRA) and gather relevant health information
• Identify member needs and coordinate appropriate referrals to clinical, behavioral health, and social support services
• Support care coordination activities, including scheduling appointments, transportation, and follow-up services
• Document all member interactions accurately and in a timely manner in electronic systems in compliance with regulatory and quality standards
• Enter, track, and maintain medical and outreach data; assist with reporting and quality metrics
• Provide members with basic benefit education and navigation support
• Collaborate with Care Management, Quality Management, and internal departments to ensure continuity of care
• Escalate clinical concerns or high-risk cases to appropriate clinical staff or leadership
• Participate in team meetings, trainings, and quality improvement initiatives
• Represent the organization professionally during outreach events and member interactions
• Perform additional duties as assigned

Required Qualifications

• High school diploma or GED required
• Minimum of one (1) year of experience in healthcare, managed care, care coordination, or member outreach
• Experience working directly with patients or health plan members
• Strong customer service and communication skills
• Ability to accurately document and manage data across multiple systems
• Proficiency with Microsoft Word, Excel, and Outlook
• Ability to manage multiple priorities in a fast-paced environment

Preferred Qualifications

• Managed care experience (Medicaid, Medicare, or health plan environment)
• Experience administering Health Risk Assessments (HRA)
• Background as a Medical Assistant, LVN/LPN, or similar clinical support role
• Bachelor’s degree in healthcare, public health, social work, or related field
• Bilingual proficiency (Spanish, Haitian Creole, Russian, or other languages)

Skills & Competencies

• Member-focused and service-oriented mindset
• Strong interpersonal and problem-solving skills
• Attention to detail and organizational excellence
• Professional, nonjudgmental, and culturally sensitive approach
• Ability to work independently and collaboratively
• High level of integrity and confidentiality

Work Environment

• Full-time, 40 hours per week
• Field-based and/or office-based outreach, depending on business needs
• May include community outreach events and member-facing activities

Why Join Us

• Opportunity to make a meaningful impact on member health outcomes
• Collaborative and mission-driven healthcare environment
• Exposure to quality management and population health initiatives

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

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