Healthcare HEDIS/Quality Operations Coordinator

Sky Mavis; Salem (OR); Hybrid; USD 30,000 - 39,000; Full time

Benefits offered by this job

Hybrid work arrangement

Travel opportunities

Job summary

P3 Health Partners in Oregon offers a Regional Quality Coordinator role with a hybrid work arrangement, three in-office days per week. You will support the Quality Management Department, engage with patients and providers, and drive improvement in HEDIS and CMS measures.

The role requires a strong foundation in healthcare quality, data oversight, and coordination across clinics, with collaboration supported by the VP and National Quality Manager. Travel within the region may be required.

Qualifications

• High school diploma/GED required; associate degree in related field or equivalent experience preferred.
• 2+ years experience in healthcare-related fields; clinical health care, managed care, or health plan experience strongly preferred.
• Experience with Microsoft Word, Excel, PowerPoint, Outlook and general office equipment.
• Electronic Health Records experience required.
• Medical Assistant Certification or Pharmacy/Pharmacy Tech/Radiology/Lab tech experience strongly preferred.
• Experience with data mining preferred.
• Medical terminology knowledge required; CPT II codes experience preferred.

Responsibilities

• Understands CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA principles.
• Supports Quality Management by improving quality of care through HEDIS, CMS Star Rating, and other quality performance reporting.
• Performs telephonic outreach to patients, providers, and pharmacies to discuss opportunities for improving medication use and other quality measures.
• Works to maximize performance on quality measures through telehealth communication and coordination with patients, caregivers, providers, and pharmacies.
• Assists in planning, implementing, and executing projects to improve quality and delivery of care services.

Skills

CMS knowledge

HEDIS familiarity

Data mining

Telehealth coordination

Education

High school diploma/GED

Associate degree or related experience

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

Overall Purpose

The Regional Quality Coordinator role is responsible of managing Quality operational support initiatives while overseeing special projects, with a focus on supporting HEDIS and Pharmacy gap closures. This position requires daily problem-solving, meticulous tracking, and coordination across departments to meet varying and changing requirements. The RQC will oversee assigned affiliate groups, providing Quality operational support to clinics to achieve their goals, which may include engaging with internal and external stakeholders with in-person and telephonic outreach to patients for education and engagement on preventative screenings, data mining, medication adherence, and follow-up with primary care providers. This position may directly interact with patients to complete tasks for quality gap closure.

The Regional Quality Coordinator will support the assigned market under the direction of the market VP with the assistance of the National Quality Manager.

Essential Functions

• Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA


• Provides support to the Quality Management Department by working with members and network providers to improve quality of care through quality activities such as HEDIS, CMS Star Rating, and other quality performance reporting


• Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other opportunities for improvement of healthcare performance measure related issues


• Improves patient experience and transitions for better healthcare outcomes through quality care


• Participates in data collecting through medical record and claims surveillance


• Works to maximize health plan and healthcare provider performance on healthcare related quality measures through effective telehealth communication with patients and coordination with patient caregivers, providers, and pharmacies.


• Assists in planning, implementing, and executing projects to improve quality and delivery of care services


• Using research and knowledge, identifies potential interventions to improve quality strategies


• Participates in Quality Management meetings and other initiatives


• Prepares quality information for presentation to affiliate groups, including groups current standings relative to others and opportunities or improvement


• Point of Contact for provider groups designated by leader


• Leads project management of Quality Fairs, Diabetic Days, and P3 events to maximize quality gap closure


• Subject Matter Expert in P3 machines (diabetic eye camera, bone density machine, etc.)


• Responds to health plan, provider and interdepartmental calls in accordance with exceptional customer service


• Reviews provider group gap uploads through the P3 Provider portal


• Other duties as assigned

Education and Experience

• High school diploma/GED required, associate degree in related field or equivalent experience preferred.


• 2+ years experience in healthcare-related fields required, clinical health care related experience, managed care, or Health plan experience strongly preferred.


• Experience with Microsoft Word, Excel, Power Point, Outlook and general office equipment such as copier, fax machine, required.


• Experience in Electronic Health Records required.


• Medical Assistant Certification or experience as a Pharmacy Tech, Radiology Tech, Lab Tech or similar strongly preferred.


• Experience with data mining is preferred.


• Medical terminology knowledge required, experience with CPT II codes preferred.

Work Conditions

• Availability to travel within assigned region and work from multiple providers offices as needed.


• Must have a valid driver’s license, safe driving record, and able to furnish reliable transportation.

Work Location & Schedule

This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.

Pay range per hour: $22 - $28 based on experience

About P3

People. Passion. Purpose.

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

We are looking for a Regional Quality Coordinator. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.