Care Quality and Navigation Coordinator

COMPANY SUMMARY:

At OnePeak Medical, we are redefining primary care. Our mission is to deliver a personalized, integrative care model that combines traditional and functional medicine to address the root causes of illness and empower patients to live healthier, more vibrant lives. Our multidisciplinary team supports patients through advanced diagnostics, hormone optimization, nutrition, lifestyle coaching, and evidence-based therapies.

JOB SUMMARY:

OnePeak Medical is seeking an experienced Lead Care Quality Coordinator to build, operationalize, and continuously improve our Care Quality function across a growing, multi-site healthcare organization. This role will help manage and operationalize Patient Centered Primary Care Home Programs (PCPCH) and other quality programs, ensuring requirements are not only met but embedded into daily clinical workflows.

This is a hands-on role designed for someone who can create structure where it doesn't yet exist and translate clinical best practices, payer-driven quality programs, and regulatory standards into scalable, operational systems—while maintaining a patient-centered focus across all sites.

RESPONSIBILITIES AND DUTIES:

Care Quality Program Build & Leadership

• Serve as the primary owner and builder of the Care Quality function across the organization.
• Partner with the Compliance, Clinical/Medical and Operational Leadership to develop the establishment and coordination of the Company's Quality Committee to promote cross-functional partnership and accountability for quality program initiatives, including implementation and oversight of the annual Quality Improvement Plan and of evidence-based Care Guidelines.
• Translate clinical standards and quality program requirements into clear, operational workflows that providers and staff can consistently follow.
• Lead the integration of Care Guidelines and quality program requirements into NextGen (templates, order sets, smart text, workflows) to support consistency at the point of care.
• Define and track key quality metrics, including outcomes, patient experience, variation in care delivery, and PCPCH-related measures.
• Maintain accurate documentation and produce executive-ready reports and dashboards for leadership review.

PCPCH & Quality Program Management

• Help manage, maintain, and operationalize PCPCH across applicable clinics, ensuring ongoing compliance with standards and successful attestations.
• Own the day-to-day operational execution of PCPCH requirements, including documentation, workflows, staff training, and audit readiness.
• Support additional quality programs (payer quality initiatives, internal quality projects, value-based care requirements, accreditation-related programs) as they are introduced or expanded.
• Partner with Operations, Compliance, and Clinical Leadership to ensure quality program requirements are embedded into normal clinic operations, not treated as add-on work.

Training, Enablement & Adoption

• Develop and deliver ongoing training programs to ensure providers and staff understand Care Guidelines, PCPCH requirements, and quality expectations.
• Act as a clinical quality resource and change agent, supporting adoption and sustained compliance with quality and care coordination standards across sites.
• Create durable training materials, SOPs, tip sheets, and toolkits to support consistency, scale, and audit readiness.

Internal Care Coordination & Complex Patient Support

• Collaborate with providers and care teams to improve coordination for complex or high-risk patients across the organization.
• Manage and operationalize all Transitional Care Management (TCM) workflows across the organization, ensuring consistency, compliance, and timely execution following hospital or facility discharges.
• Oversee patient Chronic Care Management (CCM) and care navigation services, including eligibility identification, enrollment workflows, documentation standards, and ongoing operational support.
• Build and maintain patient navigation pathways, connecting patients to appropriate internal services and external community resources (social services, specialty care, behavioral health, community-based programs).
• Identify breakdowns in care transitions and navigation, and design improved communication, handoff, and follow-up workflows.
• Partner with Operations, Clinical Leadership, and Compliance to ensure TCM, CCM, and navigation services are clinically appropriate, operationally efficient, and aligned with billing and regulatory requirements.
• Support a patient-centered, whole-person approach to care delivery across departments.

QUALIFICATIONS:

• Bachelor's degree in healthcare administration, nursing, public health, care coordination, quality improvement, or a related field (or equivalent practical experience).
• 5+ years of experience in healthcare quality, care coordination, clinical operations, population health, or related roles.
• Demonstrated experience building, implementing, or significantly improving care quality programs, care coordination workflows, or clinical standards.
• Hands-on experience operationalizing quality initiatives (e.g., PCPCH, value-based care programs, accreditation or payer quality programs).
• Strong understanding of care coordination models, including Transitional Care Management (TCM), Chronic Care Management (CCM), and patient navigation.
• Experience working cross-functionally with providers, operations, compliance, and leadership teams.
• Ability to analyze clinical and operational data, identify gaps, and translate insights into actionable improvements.