Quality Care Coordinator

Summary:  The Quality Care Coordinator is responsible for coordinating all aspects of patient care including working directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel.

Education: High School Diploma. Certified Medical Assistant (CMA) or Licensed Professional Nurse (LPN) licensure required.                                  

Experience: Minimum two (2) years of recent clinical experience.

Essential Job Functions:

• Supports quality improvement activities including data management and reporting, health insurance incentive programs, population health management, and other value-based reimbursement programs.
• Monitors key internal and external clinical quality metrics reports, performance-based compensation reports, and other performance reports.
• Collaborates with practices to identify opportunities for improvement and develops supportive plans to target opportunities using quality improvement methods and tools
• Identifies providers for targeted outreach for Quality Initiatives and Quality Improvement metrics (e.g. underperformers or those not meeting baseline goals/benchmarks)
• Assists in providing education for staff and providers on quality and population health initiatives to maintain or improve performance
• Oversees clinical data collection, completes clinical chart reviews and uploads chart records for:
• Medicare, Medicare Advantage, and other insurance programs, as indicated
• Provides support for the practice to meet organizational quality and efficiency goals through optimizing provider and patient engagement
• Coordinating with local specialist offices or other entities to coordinate care and ensure patient follow up and record collection
• Support/conduct pre-visit planning reviews for practices
• Completes Patient Assessment Forms for all eligible insurance plans and tracks progress for completion and payment
• Attend planned meetings scheduled by the Director of Care Management (DCM)
• Communicate with DCM regarding physician inquiries, requests, and/or concerns
• Communicate with the physicians regarding patient concerns and physician preferences for scheduling
• Schedules diabetic patients for diabetic education as referred by internal physicians

Knowledge, Skills and Abilities:

• Strong working medical knowledge of the clinical needs and disease processes for the chronically ill population
• Knowledge of general health care practices, office workflows, and medical terminology
• Excellent telephone, oral and written communication skills.

• Ability to work autonomously and be directly accountable for assignments
• Strong computer skills, including Microsoft office and EMR experience

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephone, calculators, etc.

Work Environment: Position is primarily in a well-lighted office environment.  This position may require limited local travel throughout the business day.

Mental/Physical Requirements: While performing the duties of this job, the employee is regularly required to talk or hear.  The employee is primarily sitting at a desk utilizing a computer.  

DISCLAIMER

The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skills required of personnel so classified. Examples listed do not preclude the performance of other duties similar in nature or in level of complexity.