Quality Care Coordinator - Value Based Care

LED FastStart•New Orleans, LA

10d

About The Position

The Care Coordinator ensures patients' experiences with the LSU Healthcare Network are seamless and comprehensive. The role reviews, plans, and coordinates healthcare services to use appropriate processes and resources to improve members' health outcomes. Using clinical and organizational knowledge, the Care Coordinator performs ongoing assessments, identifies gaps in care and referral opportunities, recognizes problems, and provides education and follow-up to coordinate care and improve patient outcomes. The role supports population health and quality improvement initiatives across value-based contracts, including HEDIS, Star, Risk, and the CMS Quality Payment Program.

Requirements

High school diploma or GED equivalent.
At least 2 years of clinical experience in a patient care environment.
Knowledge and experience with computer skills, particularly Microsoft Office products and Electronic Health Records.
Professionalism, strong verbal and written communication, planning and organizational skills, integrity, and commitment to customer satisfaction.
Conflict management and resolution skills.
Ability to manage time efficiently and effectively, work independently and proactively, and make decisions.
Ability to handle multiple demands from a diverse workload and prioritize critical issues.
Ability to interact effectively with providers, medical professional staff, and insurance payers.

Nice To Haves

Louisiana LPN license or Medical Assistant Certificate.
Experience in value-based care.

Responsibilities

Use population health management tools to increase quality outcomes and decrease healthcare costs across value-based contracts.
Develop and implement care management protocols and workflows consistent with evidence-based guidelines, practice resources, and systematic workflows.
Engage, educate, and assist physicians and staff in quality improvement and HEDIS metrics.
Assist with the CMS Quality Payment Program (QPP) for more than 800 physicians across the state.
Assist with reporting monthly quality metrics and current HEDIS, Star, and Risk scores to physicians and staff.
Work with payers to contact patients who have gaps in care.
Guide patients throughout their experience, from initial outreach through closing referral loops and following up on missed appointments.
Assist patients with scheduling appointments for testing, treatments, follow-up, and office procedures; assist with obtaining authorization or providing appropriate referral or appointment documentation.
Ensure testing, treatment, and office procedure results are received, reviewed, and accurately documented in the member record in a timely manner.
Follow up on concerns or problems until resolved and communicate resolutions to patients and physicians.
Review HEDIS, STAR, Risk, and care-gap reports with the Director of Quality at least monthly to coordinate an action plan for improved measure performance and patient outcomes.
Perform other job-related duties as requested.