Quality Care Coordinator X6

2 days ago

Orange, California, United States Eastridge Workforce Solutions Full time
Job Title: Quality Care Coordinator X6

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

Job Summary:

We are seeking a highly motivated and detail-oriented Quality Care Coordinator X6 to join our team. As a Quality Care Coordinator X6, you will play a critical role in managing assigned member outreach, closing gaps in care, and increasing HEDIS/IHA/STAR/P4P scores.

Key Responsibilities:
  • Manage assigned member outreach, including appointment calls, quality measures due, annual wellness visits, and follow-up calls.
  • Receive inbound calls from members and assist with tracking data.
  • Document details of healthcare provider interactions in quality platforms for accurate tracking.
  • Provide general education to encourage staff and providers to complete required quality measures.
  • Input alerts in EMR to notify providers and staff of outstanding items due for completion.
  • Develop and maintain P4P and HEDIS training manuals and documentation in accordance with department standards and industry best practices.
  • Assist the Manager in coordinating and preparing HEDIS medical record reviews.
  • Provide providers, staff, and members with information on nearest contracted lab locations.
  • Assist with accreditation activities, such as NCQA reviews, CAHPS, and state audits.
  • Ability to create CMS1500 forms from provider code data and discuss strengths and weaknesses with providers.
  • Request medical records from healthcare providers to verify services rendered.
  • Follow departmental policies and procedures for audit compliance.
  • Assist outside departments with facilitating PCP transfers, answering questions, and conducting follow-up calls.
  • Populate the database with new member demographic information.
Requirements:
  • High School Diploma or General Education Development (GED) required.
  • 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.
Benefits:

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.

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