HEDIS/Star Quality Navigator — Value-Based Care

Nmpca; Espanola (NM); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

401(k) Retirement Plan

7 Paid Holidays

Paid Sick Time

Comprehensive Medical, Dental, and Vis

100% Employer-Paid Basic LifeInsurance

Voluntary Employee Supplemental Benefi

Employee Assistance Program (EAP)

Education Reimbursement

Flexible Spending Account (FSA)

Job summary

El Centro Family Health is seeking a Value-Based Clinical Quality Coordinator to promote consistency and streamline processes across provider groups for 4-star quality. You will support quality initiatives, review records, and drive HEDIS/Star improvements within our NM region.

In this role, you collaborate with Clinical Quality, Network Management, and leadership, navigating EMR systems and delivering actionable recommendations for performance improvement.

Qualifications

• Three years of experience in care operations, provider reimbursement, analytics, or value-based care.
• At least four years of overall healthcare experience.
• Two years of experience in provider-facing roles.
• Proficiency in Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel.
• ADN with an active RN license in New Mexico or a compact state; or an LPN with 5+ years HEDIS/Star program experience.
• Ability to interpret clinical data and provide actionable recommendations for improvement.
• Valid New Mexico driver's license.

Responsibilities

• Conduct medical record reviews, data collection, data entry, and chart retrieval to identify and close gaps in care and improve HEDIS/Star ratings.
• Collaborate with Clinical Quality, Network Management, and Risk Education teams to identify trends and develop strategies to support assigned practices.
• Monitor and analyze barriers within the assigned region, recommending solutions to improve outcomes.
• Navigate multiple electronic medical record (EMR) systems to retrieve documentation and support quality performance initiatives.
• Maintain up-to-date knowledge of HEDIS and Star performance measures.

Skills

Care operations

Provider reimbursement

Analytics

MS Office

Education

ADN with RN license (NM or compact)

LPN with 5+ years HEDIS/Star exp

Job description

El Centro Family Health is seeking a Value-Based Clinical Quality Coordinator to promote consistency and streamline processes across provider groups for 4-star quality. You will support quality initiatives, review records, and drive HEDIS/Star improvements within our NM region.

In this role, you collaborate with Clinical Quality, Network Management, and leadership, navigating EMR systems and delivering actionable recommendations for performance improvement.