Department: Quality (Accountable Care Organization)
Job Type: Full Time
Job Hours: 40 hours per week; 8:00am-5pm Monday-Friday
Collaborate and support provider offices in the Medicare, Commercial & Medicaid value-based care programs reviewing quality program requirements working toward performance improvement.
Manage and review ACO/payer-specific incentive program contracts/registries/portals to identify care gaps and opportunities for outreach and care gap closure.
Tracks and monitors ACO/payer-specific measures related to quality and cost reporting to Director of Quality, Providers, and offices on a monthly basis.
Provides training and coaching on operational best practices (scheduling, EHR templates and technology).
Performs targeted quality control and quality assurance reviews of documentation by staff and providers for quality programs and assures compliance.
Develop and maintain strong partnerships with Providers and offices to ensure effective and timely communications of quality improvement strategies.
Provide day-to-day and monthly practice support in any area of the ACO/payer incentive programs.
Conducts medical record reviews for accuracy in ACO/payer-specific quality and cost measure programs.
Participates in ACO/health plan quality meetings to review clinic progress, identify areas of improvement, and identify operational strategies for improvement.
Educates Providers and offices on new initiatives.
Demonstrates commitment to providing outstanding customer service in a manner that is reflective of the company mission, values, and customer service standards.
Travel to various Provider offices required.
Performs other duties as assigned.
Registered Nurse or Licensed Practical Nurse preferred.
Additional experience in ambulatory care, home health, physician practice, utilization management, or other community setting preferred.
Three years + in Healthcare setting.
Ability to work independently in fast-paced environment.
Excellent customer service, troubleshooting, and decision-making skills.
Ability to communicate orally and in written form clearly and assertively.
Ability to analyze, plan, think critically and problem-solve effectively.
Ability to organize, prioritize, and be flexible.
Ability to work well within a variety of teams.
Strong attention to detail.
Demonstrate and maintain high level of accuracy.
Proven customer relation skills.