- Direct Placement
- Member Services
- Alhambra, CA
Quality Care Improvement Coordinator
Quality Care Improvement Coordinator
The QCI Coordinator is responsible in providing department support to QCIT by working with our network providers in improving the quality of care through quality improvement activities that will encompass HEDIS, CMS Star Rating, and health plan reporting. The duties and responsibilities will apply to all IPAs managed by Company
- Collecting and collating appropriate data from IPA network providers for HEDIS measures
- Advise and coach provider practices on CMS guidelines for Star Measures (Part C & D) and appropriate documentations and coding for HEDIS reporting
- Collect medical records, conduct reviews and ensure accuracy of documentation for reporting
- Collect, summarize and trend provider performance data to include provider education
- Participating in ongoing discussions concerning data collections and analysis for Hedis gap in care
- Support and research for quality improvement program studies
- Assist in planning and implementation of projects to improve delivery of services and quality of care
- Understand the principles of HIPAA and maintain confidentiality of patient health information
- Understand the principles of CMS, HEDIS, NCQA and more
- Provide in-service training to providers regarding HEDIS and CMS Star Measures
- Communicate internally and externally as needed to gather necessary data
- Attend to provider and interdepartmental calls in accordance with exceptional customer service
- Promotes a positive working relationship between NMM, IPA's and health plan.
- Attend IPA and health plan meetings as required
- Respond to IPA and health plan questions/inquiry in a timely manner
- Performs duties in a professional manner, utilizing time and resources efficiently
- Performs other duties, project and actions as assigned
- Bachelors' degree in Health Administration or any related field from an accredited institution.
- A minimum of one year health plan, IPA or MSO experience is a plus.
- Must value operating in a collaborative and cooperative environment
- Ability to show initiative good judgement and resourcefulness.
- Basic knowledge of ICE, Client, DMHC, NCQA, and CMS standards.
- Excellent written and oral communication skills, as well as strong interpersonal, critical thinking and analytical skills.
- Excellent organizational, decision-making and multi-tasking skills.
- Excellent presentation, verbal and written communication skills and ability to collaborate with co-workers, senior leadership and other management.
- Proven ability to prioritized and organize multi-faceted/multiple responsibilities simultaneously in a fast paced, changing environment while meeting deadlines and turnaround time requirements
- Must be able to work independently utilizing all resources available while staying within the boundaries of duties
- Must possess the ability to educate and train staff members and other departments as needed
- Ability to keep a high level of confidence and discretion when dealing with sensitive matters relating to providers, members, business plans, strategies and other sensitive information is required.
- Must be ethical and possess the ability to remain impartial and objective
- Must be able to travel 20% of work time
- Proficient with Microsoft Office (Word, Excel, Power Point) and EZCAP.
- Personal & Professional Qualities
- Punctuality, Creativity, Self-motivation
- Professional appearance and conduct.
- Conceptual and "big picture” understanding
- Able to function independently under time constraints
- Willing to learn and develop new responsibilities and skills
- Good organization, critical thinking and problem solving skills
- Must be detail-oriented and able to work autonomously but also as a team member
- Should have strong communication and customer service skills and respect for confidentiality
- Full Time Direct Hire