Healthcare Performance Optimization Specialist
7 days ago
Job Title: Healthcare Performance Optimization Specialist
Location: Providence Community Center LLC
Estimated Salary: $70,000 - $90,000 per year
About the Role:
This role involves overseeing and optimizing the performance of Medicare-related services for our healthcare plans. The successful candidate will have experience in healthcare management, preferably in Medicare services, and strong organizational and communication skills.
Responsibilities:
- Review daily hospital census, including Emergency Room (ER) visits and inpatient stays.
- Contact patients to schedule follow-up visits within 7 days of ER and inpatient stays.
- Analyze Medication Adherence Reports to ensure patients are following prescribed regimens.
- Review all referrals to ensure they are directed to approved providers.
- Reconcile specialist referrals with consultation reports, ensuring proper documentation is scanned into patient charts.
- Call new patients to welcome them to the center, schedule their initial appointments, and request previous medical records.
- Conduct monthly meetings with department heads to gather statistics related to HEDIS metrics, billing and coding performance, and Medical Risk Adjustment (MRA) assessments.
- Evaluate RX Cost Saving Reports and implement required medication switches to optimize cost-effectiveness.
- Reconcile ten patient charts monthly and present outcomes to stakeholders during the monthly meeting.
Qualifications:
- Fluency in both Creole and English is required.
- Experience in healthcare management, preferably in Medicare services.
- Strong organizational and communication skills.
- Ability to work collaboratively with multidisciplinary teams.
- Proficient in data analysis and reporting.
- Knowledge of HEDIS metrics and compliance standards.
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