Quality Management Chronic Care Specialist

1 week ago

Winter Haven, Florida, United States Bond Clinic Full time
General Summary of Duties: This position is responsible for providing critical analyst support to the Quality Management Department by contacting patients with chronic disease states by enrolling patient into the program. This team also works with patients being discharged from a hospital setting to ensure they know when their hospital follow up appointment was scheduled. Responsibilities of being a Chronic Care Specialists include Electronic Medical Record reviews, data collection from patient, chart abstractions when needed, reporting and analysis. Coordinates and performs onsite medical record reviews to ensure all the information needed to perform a call is obtained. Works with Physicians / Staff to identify patients with Disease states that may qualify for our Chronic Care Management Program.

Examples of Duties: (This may not include all of the duties assigned)
  • Review Hospital activity report daily to review if patients meet the Chronic Care Management criteria. Work with Primary Care Physician to authorize initiation into Chronic Care Program.
  • Daily phone calls to patients in Chronic Care Management Program to review a series of questions to be documented in patients file.
  • Work with Physicians and Staff to assist Chronic Care Members with needs.
  • Keep appointment schedule to ensure all patients enrolled in program receives a monthly check in call. Update EHR and database when call is made.
  • Update each Chronic Care phone call with details from answers from the patient in Electronic Medical Record and task to Physician to sign and review.
  • Call to patients to check on status and educate on disease state per physicians request
  • Analyze and evaluate various sources of data to improve quality and further the goals and objections of the organization.
  • Research best practices, national and regional benchmarks, and industry standards.
  • Develop and produce reports that monitor, benchmarks utilization and other quality and performance standards.
  • Monitor for adverse trends, recommend modifications and corrective actions as needed
  • Perform medical record reviews, data collection, chart abstractions, reporting and analyses
  • Provide analytical support to internal departments regarding quality improvement activities.
  • Call discharged patients within 24-48 hours to ensure they know when hospital follow up appointment is scheduled. Making sure they have everything they need to stay healthy including but not limited to medications, DME, care and support in the home etc.
  • Work with patients to complete survey questions on hospitalists, hospital stay. Data kept in a database for reporting purpose to Director. Director will review results weekly and report to Administration and Hospitalist on a quarterly basis.
  • Participate in relevant committees and work groups; make presentations; prepare reports, data or other material for presentation.
  • Perform all other duties as assigned by Director
Performance Requirements:

Knowledge, Skills, & Abilities:
  • Knowledge base of clinical standards of care, preventative health standards, HEDIS, and the managed care industry.
  • Candidate should possess strong organizational skills and ability to work both independently and with teams.
  • Candidate must have the ability to evaluate medical records with attention to detail.
  • Ability to interact with medical staff, peers and internal company staff at all levels
  • Ability to use databases and prepare reports as needed.
  • Proficient in software applications that include, but are not limited to Microsoft Word, Microsoft Excel, and Outlook.
  • Demonstrates ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets.
  • Ability to use problem solving skills; the ability systemically analyze problems, draw relevant conclusions and devise appropriate course of action.
  • Must have good communication skills to interface and be very detail oriented.
Education: High School Diploma or GED required.

Experience:
  • CMA, LPN, RN preferred, but not required
  • 1-2 years of experience with healthcare; managed care; or HEDIS data analytics
  • Computer experience required
  • Procedural and ICD-10 Coding experience, Physician Office experience, Chart abstractor/reviewer a plus
Certificate/License: CMA, LPN, RN preferred, but not required

Bond Clinic is a Drug Free Workplace and an Equal Opportunity Employer. Bond Clinic will provide reasonable accommodation to complete the online application consistent with applicable law. If you require an accommodation, please contact Human Resources.

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