Clinical Quality Care Coordinator

FLSA Status

Non-Exempt

Job Role Summary

The Clinical Quality Care Coordinator is responsible for closure of care gaps associated with managed care contracts, HRSA and Joint Commission standards, CMS and NCQA programs. This position assists with the implementation of appropriate methods of quality assurance and improvement activities as part of the Quality Management Program.

Essential Functions and Responsibilities

• Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County. Models Eskenazi values of P.R.I.D.E. (Professionalism, Respect, Innovation, Development and Excellence)
• Utilizes general understanding of quality metrics and quality incentive programs (ex: HEDIS, MIPS, PCMH, pay for performance, managed care, UDS)
• Assists in the implementation and effectiveness analysis of appropriate methods of quality assurance and quality improvement projects and activities as part of the Quality Management Program
• Interacts with all internal and external customers in a caring and respectful manner in accordance with our Core Values philosophy
• Cofacilitates successful achievement of outreach, process improvement, external incentive, recognition programs, or contracted programs and adoption of standards of work (SOW)
• Serves as a resource on assigned incentive programs 
• Collaborates with quality team to ensure successful improvement and achievement of quality incentive programs
• Partners with payers to utilize their reporting mechanisms as a resource to identify potential areas of improvement on assigned incentive programs 
• Leverages clinical quality best practices including identifying opportunities to create new or change existing best practices while ensuring compliance with regulatory and safety standards
• Leverages Epic and project management tools to track progress of care gap closure for assigned programs
• Participates in formal presentations and trainings to various levels in the organization and externally
• Assists in medical record reviews, quality control reviews, and regular audits to ensure data integrity and opportunities for improvement
• Partners with community and external organizations to reduce barriers to care 
• Cofacilitates meetings with internal and external customers in an organized and professional manner
• Responsible for adherence to the data governance process and uses data for decision making. Ensures data integrity, policy adherence, proper storage and utilization, and analysis of data to assist with improvement and monitoring of performance.
• Coordinates assigned quality and process improvement efforts which includes, but is not limited to quality studies, auditing, program maintenance, patient experience efforts, regulatory program, care coordination, monitoring and evaluating effectiveness of improvement efforts.
   

Job Requirements

• Completion of a high school education or equivalent required
• Completion of Medical Assistant or Pharmacy Technician program required
• Certified or Registered Medical Assistant preferred
• Medical Assistant or Pharmacy Technician with 3 years’ experience required
• Cross-functional project management experience preferred
• Healthcare Quality Improvement experience preferred
• Investigative, problem solving, organization and analytical skills required
• Valid Driver’s License
• Knowledge of Medicaid Managed Care and quality incentive programs preferred

Knowledge, Skills & Abilities

• Ability to establish and maintain credibility and build effective relationships 
• Ability to effectively communicate verbally and in writing to various levels of management
• Ability to interpret and present data at staff, peer, management, and committee level
• Knowledge of medical terminology
• Demonstrated competence/knowledge of healthcare field
• Strong PC skills (including Excel, Access, Visio, other reporting database management systems) required
• Ability to work independently
• Able to prioritize and manage multiple tasks/priorities simultaneously
• Detail-oriented
• Good organizational skills
• Displays good judgment in apprising management of situations that are incompatible with established policies for which there is little precedence