Healthcare Operations Coordinator

1 week ago


Orange, California, United States Eastridge Full time
Job Summary

Eastridge Workforce Solutions is a leading provider of workforce management solutions, committed to connecting skilled professionals with meaningful career opportunities.

We are seeking a highly motivated and detail-oriented Healthcare Operations Coordinator to join our team. As a Quality Care Coordinator, you will play a critical role in managing assigned member outreach, tracking data, and documenting healthcare provider interactions.

Key Responsibilities
  • Member Outreach Management: Close gaps in care and increase HEDIS/IHA/STAR/P4P scores by managing assigned member outreach, including appointment calls, quality measures due, annual wellness visits, and follow-up calls.
  • Data Tracking and Documentation: Receive inbound calls from members, track data, and document details of healthcare provider interactions in quality platforms, such as Cozeva.
  • Quality Measures and Training: Provide general education to encourage staff and providers to complete required quality measures and develop and maintain the P4P and HEDIS training manual and documentation.
  • Alerts and Notifications: Input alerts in the Electronic Medical Record (EMR) to notify providers and staff of outstanding items due for completion.
  • Accreditation Support: Assist in support of accreditation activities, such as NCQA reviews, CAHPS, and state audits.
  • Lab Services and Medical Records: Provide members with information on the nearest contracted lab location for lab services and request medical records from healthcare providers to verify services were rendered.
  • Database Management: Populate the database with new member demographic information.
  • Special Projects: Assist with special projects as needed.
Qualifications
  • Education: High School Diploma or General Education Development (GED) required.
  • 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: Eastridge Workforce Solutions offers a competitive benefits package to its temporary employees. Please visit our website to learn more about the benefits available.

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.



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