Quality Assurance Clinical Coordinator
The Quality Assurance Clinical Coordinator is responsible for organizing and overseeing the administrative aspects of health and clinical services related but not limited to NCQA, HEDIS and the Pharmacy Benefit Management and Quality Management Committees. The Quality Assurance Clinical Coordinator will work closely with the Quality Assurance Department to ensure that documentation and follow up activities related to patient care are optimized for efficient and compliant provision of high quality patient care.
Duties and responsibilities
- Coordinate with the Pharmacy Benefit Management vendor and the Pharmacy Benefit Management Committee regarding meetings, materials, and adherence to delegated activity standards
- Coordinate with the Quality Management Committee, internal departments and Care Management and Disease Management vendor regarding meetings, materials, and adherence to delegated activity standards
- Responsible for administration of the Behavioral Health Workgroup and other clinical workgroups as needed
- Manage quality initiative projects
- Collaborate with team in clinical program goal setting, progress evaluations, and ongoing problem solving
- Participate in clinical conference calls, staff meetings and trainings
- Oversee patient communication and adherence to regulatory standards
- Oversee healthcare provider communication and adherence to regulatory standards
- Conduct internal and external clinical and care management audits
- Maintain expertise in billing practices and software systems used to accomplish tasks
- Develop and maintain expertise in the requirements and parameters of NCQA, Centers for Medicare and Medicaid, and Department of Insurance (DOI)
- Visit provider sites as needed in order to provide information and education on HEDIS, Risk Adjustment, and clinical programs
- Other duties as may be assigned
- Bachelor's Degree in Health Care Administration, Nursing, Business or related field
- Broad-based business experience within the healthcare/managed care environment
- Knowledge of HEDIS (Healthcare Effectiveness Data and Information ) Measures
- Two or more years of experience in healthcare quality improvement or accreditation department; managed care experience strongly preferred
- Ethics - Honest, accountable, maintains confidentiality
- Reliability - The extent to which the employee can be depended upon to be available for work, do it properly, and complete it on time. The degree to which the employee is reliable, trustworthy, and persistent.
- Sense of Urgency - Meets deadlines, establishes appropriate priority, gets the job done in a timely manner
- Planning & Organizing - Displays ability to effectively plan, organize and implement applicable tasks or projects in relation to established goals and objectives
- Problem Solving & Decision Making - Displays ability to define a problem, develops workable and realistic alternatives, and selects appropriate alternative to resolve problem. Decisions made are generally correct, and the time taken to make such decisions is reasonable
- Communication skills - Possesses effective communication skills: oral, written, listening
- Dependability - Completes job assignment and projects with minimal supervision. Meets schedules and deadlines
- Decision making - Able to reach decisions, takes thoughtful approach when considering options, seeks input from others, makes difficult decisions
- Innovation - Knowledge of approaches, tools and techniques for promoting creative, original thinking and applying it to existing and emerging situations
- Customer service - Works well with customers, promotes a positive image of the company, strives to solve issues raised by customers
Physical, Mental, Environmental & Working Conditions
Moderate amount of walking, sitting, and writing. Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day events in the execution of job duties. Need for flexibility and adaptability to change. Candidate must be self-disciplined and a self-starter and able to work independently with a flexible work schedule.
HealthOne is an organization owned and governed by local health care providers focused on community health needs of North Georgia. HealthOne was formed to work directly with industry for their health network needs associated with their managed group health benefit plan.
HealthOne's goal is to bring healthcare decision making back to the community with physicians and patients in control of their medical care.
Thu, 21 Sep 2017 08:23:30 PDT