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Quality Care Coordinator
2 months ago
Eastridge Workforce Solutions is a leading provider of workforce management solutions, committed to connecting skilled professionals with meaningful career opportunities.Eastridge is hiring a for Quality Care Coordinator healthcare services company. For immediate consideration apply today.
Job Responsibilities/Duties
- Manage assigned member outreach (appointment calls, quality measures due, annual wellness visits, follow-up calls, etc.) by closing gaps in care and increase HEDIS/IHA/STAR/P4P scores.
- Receive inbound calls from members and assist with tracking data, etc.
- Document details the healthcare provider conducts in quality platforms (Cozeva, etc) communication module for accurate tracking.
- Provide general education to encourage the staff and providers to complete the required, “due” quality measures.
- Input alerts in EMR to notify providers/staff of current outstanding items due for completion.
- Develop and maintain the P4P and HEDIS training manual and documentation in accordance with department standards and industry best practices
- Assist the Manager in the coordination and preparation of the HEDIS medical record review, which includes outgoing review of records submitted by providers and the annual HEDIS medical record review.
- Provide the providers, staff, and members with the nearest contracted Lab location to have lab services rendered.
- Assist as needed in support of accreditation activities such as NCQA reviews, CAHPS, and state audits.
- Ability to create CMS1500 forms from the provider code data
- Ability to discuss with providers the strengths and weakness while coding
- Request medical records from healthcare providers to verify services were rendered, per member’s verbal reporting.
- Follow all departmental Policies and Procedures for audit compliance.
- Assists outside departments with facilitating PCP transfers, answering questions, and conducting follow-up calls; as needed.
- Populate database with new member demographic information.
- Helps with special projects, as needed.
Qualifications
- Minimum Education: High School Diploma or General Education Development (GED) required.
- Minimum Experience: A minimum of three plus (3+) years of IPA/HMO experience and one plus (1+) year/s in P4P/HCC/CMS Star Programs experience. Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone while maintaining a professional demeanor.
Benefits: Use this link bit.ly/4cGUQSh to learn more about benefits available to Eastridge’s temporary employees.From time to time Eastridge’s clients may offer additional benefits to Eastridge employees while on assignment.Information about those benefits will be communicated when applicable.
Eastridge Workforce Solutions is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. We celebrate diversity and are committed to creating an inclusive environment for all employees. Please note that Eastridge is unable to provide visa sponsorship to applicants.
Certain clients require Eastridge to perform background checks and Eastridge will consider qualified applicants with criminal histories in a manner consistent with any applicable federal, state, or local law regarding criminal backgrounds, including but not limited to the Los Angeles Fair Chance Initiative for Hiring and the San Francisco Fair Chance Ordinance.
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