Value Based Clinical Quality Coordinator

Nmpca; Espanola (NM); In loco; USD 70.000 - 100.000; Tempo pieno

Vantaggi offerti da questo lavoro

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)

Descrizione del lavoro

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.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

Care operations

Provider reimbursement

Analytics

MS Office

Formazione

ADN with RN license (NM or compact)

LPN with 5+ years HEDIS/Star exp

Descrizione del lavoro

Position Overview:

The Value-Based Clinical Quality Coordinator is responsible for promoting consistency, streamlining processes, and sharing best practices across assigned provider groups to achieve a minimum 4-star quality performance. This role works directly with providers and participates in quality improvement initiatives to enhance patient outcomes. The Coordinator is accountable for quality performance within their designated region and collaborates closely with market teams and leadership in a matrixed environment.

What You Will Do:

• 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.
• Perform additional duties as assigned to support organizational goals.

Minimum 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.
• Associate Degree in Nursing (ADN) with an active RN license in New Mexico or a compact state; alternatively, a Licensed Practical Nurse (LPN) with 5+ years of HEDIS/Star program experience may be considered.
• Ability to interpret clinical data and provide actionable recommendations for improvement.
• Valid New Mexico driver's license.

Preferred Qualifications:

• Two years of experience with HEDIS/Star programs, preferably in a clinical quality or consulting role.
• Experience in data analysis, chart review, and clinical abstraction.
• Knowledge of billing practices and CPT coding.
• Bachelor of Science in Nursing (BSN).
• Experience with Medicare and/or managed care programs.

Physical Requirements:

• Ability to balance, bend, lift, carry, and pull up to 20 lbs.
• Ability to sit and stand for extended periods, typically longer than four hours.
• Flexibility to work a varied schedule, including evenings, weekends, or as needed.
• Manual dexterity and ability to use hands and fingers for feeling, grasping, and operating office equipment.
• Adequate hearing ability for communication and monitoring office environments.
• Good vision for reading documents, operating office equipment, and observing surroundings.
• Capability to stoop, crouch, crawl, or kneel as necessary for office tasks.
• Ability to talk clearly and effectively for communication.
• Ability to walk and move around the office environment.

What We Offer:

• 401(k) Retirement Plan
• 7 Paid Holidays
• Paid Sick Time
• Comprehensive Medical, Dental, and Vision Insurance
• 100% Employer-Paid Basic Life Insurance
• Voluntary Employee Supplemental Benefits
• Employee Assistance Program (EAP)
• Education Reimbursement
• Flexible Spending Account (FSA)

Who We Are:

As a Federally Qualified Health Center (FQHC) and 501(c)(3) nonprofit, El Centro Family Health is dedicated to providing affordable, accessible, and high-quality healthcare to the people of Northern New Mexico. Our mission is to enhance the quality of life in our community by delivering primary care and health education through a network of clinics and collaborative programs. At El Centro, we are committed to offering vital health services in a compassionate, supportive, and patient-centered environment.

Equal Employment Opportunity Statement:

El Centro Family Health is an equal opportunity employer. We do not discriminate based on race, color, religion, gender, gender identity, sexual orientation, national origin, disability, age, veteran status, or any other protected characteristic. We are committed to fostering a diverse and inclusive workplace for all.