Quality Management Specialist

4 weeks ago

Fresno, United States Sante Health Full time

NOT A REMOTE/HYBRID POSITION

A challenging and rewarding opportunity awaits a new Quality Management Specialist at Sante Health System in Fresno, CA. In collaboration with the department team, the Quality Management Specialist will assist in facilitating Population Health program activities and operations. Providing administrative and operations support for various organization-critical initiatives, projects and processes within the Quality Management Department. Department activities span across various lines of payer business including Medicare, MediCal, Commercial, and Accountable Care Organization (ACO) as well as various provider specialty and groups.

Additionally, the Quality Management Specialist supports the various programs' educational objectives and effectively interfaces with clinical partners to successfully monitor and improve electronic medical record efficacy, with a primary focus on Hierarchical Condition Category (HCC) capture rates, Healthcare Effectiveness Data and Information Set (HEDIS), Pay-for-Performance and Medicare STARS quality measures.

QUALIFICATIONS
  • Three to five years' previous experience with HEDIS measures, Medicare Risk Adjustment, or experience in a clinical office setting, primary care preferred.
  • Demonstrated ability in the following skill set:
    • Interpretation of technical data specifications
    • Critical thinking
    • Excel spreadsheet use
    • Problem-solving
    • Research
    • Project management
    • EMR and data aggregator software
    • Communication, verbal and written
    • Presentation Skills
ESSENTIAL FUNCTIONS
  • Provides administrative support to ensure success of IPA's Medicare Risk Adjustment, HEDIS and CMS STARS initiatives.
  • Educates and advises provider and/or office staff on program initiatives.
  • Assists in the Retrieval of Information (ROI) process for participating health plans, and Santé Foundation Medical Group providers where access is available.
  • Presents information and responds to questions from clinic sites, members, internal staff, vendors, and health plan representatives.
  • Prepares and presents reports as requested.
  • Identifies process issues and make recommendations for improvement.
  • Provides varied administrative and project management support within the Quality Management department.
  • Participates in health plan and department team meetings as needed.
  • Works with other departments and health plans to identify and collect data needed for reporting and department communications.
  • Other functions and accountabilities may be assigned.
PERFORMANCE REQUIREMENTS
  • Proficient technical skills with MS Office (Excel, Word, Outlook and PowerPoint).
  • Good organization, analytical, interpersonal, and strong communication skills.
  • Experience and expertise with medical practice management software, knowledge of various EMR systems is a plus.
ESSENTIAL DUTIES AND RESPONSIBILITIES

All duties and responsibilities are essential job functions and are subject to possible modification to reasonably accommodate individuals with disabilities. Other functions and accountabilities may be assigned from time to time. Regular attendance is an essential function of this position. To perform this job successfully, the employee will possess the skills, aptitudes, and abilities to perform each duty proficiently.

ABOUT SANTE HEALTH SYSTEM

Sante Health System is a Management Services Organization that serves multiple clients. "Sante" is the French word for health. Our name symbolizes our commitment to good health, progressive care, and leadership in our community.

Sante is one of the largest health care claims and billing management companies in Central California. The strength of Sante is the extraordinary network of physicians, health plans, and other health service providers it offers the people of our valley. Sante coordinates with physicians, health plans, hospitals, and ancillary providers to ultimately benefit the patient in a managed care environment. Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.

Sante is celebrating over 25 years of service to the community. We deeply understand that we would not be successful in enhancing the quality of life of our patients without our incredible team. Therefore, we have created a work culture that is comprised of talented, driven, dedicated, innovative, and service-driven professionals. We provide competitive pay, excellent benefits including medical, dental, vision, and life insurance, 401k retirement plan, paid time off, and opportunities for advancement. Being part of our team is like being part of a big family. Join our team and make Sante Health System your home away from home.

READY TO JOIN OUR TEAM?

We understand your time is valuable, so we have a very quick and easy application process. If you feel that you would be right for this job in health care, please fill out our initial 3-minute, mobile-friendly application. We look forward to meeting you

www.santehealth.net

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