Quality Care Coordinator

The Quality Care Coordinator assists in accomplishing the highest percentage of member compliance for Healthcare Effectiveness Data and Information Set (HEDIS) and STAR measures annual goals. The Quality Care Coordinator runs, analyzes and maintains reports from the Electronic Health Record (EHR) and other databases to conduct targeted outreach and scheduling, and provide general health education to members. 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities
to perform the essential functions.

Education/Experience/Skills

• High school diploma or equivalent required. Certified Medical Assistant or LPN Certification strongly preferred.
• Minimum of 2 year’s experience working in a healthcare clinic setting.
• Minimum of 12 months experience in a customer service position.
• Excellent communication and customer service skills.
• Demonstrated initiative, ability to work collaboratively and good professional judgment. 

Language Ability

• Ability to communicate effectively in a team environment.
• Ability to speak effectively in front of an audience.

Math Ability

• Basic mathematical skills.

Reasoning Ability

• Ability to multi-task and prioritize
• Demonstrates good judgement and decision making skills.

All duties are to be performed according to the established standard and in compliance with all company policies and procedures while maintaining company standards:

• Manage assigned member workload by conducting outreach (inbound/outbound calls, texts, portal messages, scheduling appointments) to members to encourage timely access to appropriate care, address open care gaps and increase HEDIS/STAR scores.  
• Document detailed conversations and maintain EHR information for assigned member workload to ensure accurate tracking and follow up.
• Runs, analyzes and maintains reports from EHR and other databases to prioritze targeted member outreach and scheduling.
• Prepares patient charts for visits and communicates with provider regarding care gaps to ensure compliance and adherence to quality measures
• Educates patients by providing information and instructions regarding medications, labs and screenings
• Identify and report potential barriers to compliance recognized during communication with members.
• Provide culturally and linguistically appropriate general education to members to encourage health literacy.
• Assists with special projects as needed related to achievement of HEDIS/STAR goals.
• Attend departmental meetings and meetings with external partners to drive quality improvement initiatives.
• Keeps abreast of annual changes released by NCQA, CMS, etc.
• Other duties as assigned.