Value Based Clinical Quality Coordinator

El Centro Family Health; Espanola (NM); On-site; USD 60,000 - 80,000; Full time

Benefits offered by this job

401k Retirement

Paid Holidays

Medical, Dental, Vision Insurance

Employer Paid Life Insurance

Flexible Spending Account (FSA)

Job summary

A community-focused healthcare provider in Espanola, NM is looking for a Full-Time Clinical Quality Coordinator. This role emphasizes driving quality performance and supporting provider engagement and improvement initiatives. Candidates should possess strong communication skills, healthcare experience, and proficiency in Microsoft Office applications. Key responsibilities involve analyzing data to enhance service delivery. Comprehensive benefits are offered, including 401k and health insurance.

Qualifications

• RN or LPN with 5+ years in HEDIS/STAR programs.
• 4+ years in healthcare and 2+ years in provider-facing roles.
• Experience in managing care operations and value-based care.

Responsibilities

• Drive consistency and quality performance in assigned region.
• Participate in quality improvement initiatives and meetings.
• Analyze financial and performance data to identify improvement opportunities.

Skills

Communication skills

Attention to detail

Data analysis

Microsoft Office Suite

Education

Associate's Degree in Nursing

Bachelor of Science in Nursing (BSN)

Tools

Microsoft Excel

Microsoft Word

Outlook

PowerPoint

Job description

As a Federally Qualified Health Center, 501c3, our mission is to provide affordable, accessible, quality health care to the people of Northern New Mexico. We strive to improve the quality of life by bringing primary health care and basic health education to the people of Northern New Mexico through a system of clinics and cooperative programs. El Centro offers vital health services in a caring and supportive environment.

El Centro Family Health is seeking a Full-Time Value Based Clinical Quality Coordinator dedicated to serving the needs of our community.

An ideal candidate should possess the following qualities:

• Strong interpersonal communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Attention to detail.
• Willing to travel to outlying clinics as needed.
• Excellent communication skills.
• Knowledge and fluent skills of Microsoft Office Excel and Word applications, internet explorer usage, and Outlook.

PURPOSE

The Clinical Quality Coordinator RN, will drive consistency, efficient process and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 stars quality performance.

The Clinical Quality coordinator RN will be provider facing and participate in quality improvement initiatives. Attend monthly or joint operating committee meetings and develop recommendations for quality improvement. This position is responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship.

DISTINGUISHING CHARACTERISTICS

• Analyzing financial, utilization and performance data to identify opportunities to drive improvement in quality and/or reduction in total cost of care.
• Completes scorecard creation and reconciliation of provider performance based on contractual terms.
• Analyzes utilization data to reconcile providers disputes.
• Design and contribute to the development of provider reporting packages to help providers understand their overall performance.
• Partners with finance team to conduct impact analysis and modeling for new values base models.
• Contributes to developing solutions to operational gaps.
• Monitors value base model performance to identify opportunities to enhance model design based on internal and external feedback and performance data.
• Experience in Medicaid and Medicaid managed care.

MINIMUM REQUIREMENTS

• Associate's Degree Nursing (ADN)NM and/or a compact state. In lieu of RN license, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable.
• 4+ years of healthcare experience.
• 2+ years of experience in provider-facing interactions.
• Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets.
• Ability to review clinical data and provide recommendations for improvement.
• 75% local travel and valid NM Driver's License.

Experience

Minimum of three years' experience in managing care operations, provider reimbursement and analytics and value-based care

PREFERRED REQUIREMENTS

• Bachelor of Science in Nursing (BSN)
• 2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
• Billing and CPT coding experience
• 2+ years of data analysis and/or quality chart review and abstraction
• Medicare and/or Managed Care experience

Benefits

• 401 k Retirement
• 7 Paid Holidays
• Medical, Dental, Vision Insurance
• 100% Employer Paid Basic Life Insurance
• Employee Voluntary Supplemental Benefits
• Employee Assistance Program
• Flexible Spending Account (FSA)