Value Based Clinical Quality Coordinator

El Centro Family Health•Espanola, NM

About The Position

As a Federally Qualified Health Center, 501c3, our mission is to provide affordable, accessible, quality health care to the people of Northern New Mexico. We strive to improve the quality of life by bringing primary health care and basic health education to the people of Northern New Mexico through a system of clinics and cooperative programs. El Centro offers vital health services in a caring and supportive environment. El Centro Family Health is seeking a Full-Time Value Based Clinical Quality Coordinator dedicated to serving the needs of our community. An ideal candidate should possess the following qualities: Strong interpersonal communication skills and the ability to work effectively with a wide range of constituencies in a diverse community. Attention to detail. Willing to travel to outlying clinics as needed. Excellent communication skills. Knowledge and fluent skills of Microsoft Office Excel and Word applications, internet explorer usage, and Outlook. PURPOSE The Clinical Quality Coordinator RN, will drive consistency, efficient process and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 stars quality performance. The Clinical Quality coordinator RN will be provider facing and participate in quality improvement initiatives. Attend monthly or joint operating committee meetings and develop recommendations for quality improvement. This position is responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship. DISTINGUISHING CHARACTERISTICS Analyzing financial, utilization and performance data to identify opportunities to drive improvement in quality and/or reduction in total cost of care. Completes scorecard creation and reconciliation of provider performance based on contractual terms Analyzes utilization data to reconcile providers disputes Design and contribute to the development of provider reporting packages to help providers understand their overall performance Partners with finance team to conduct impact analysis and modeling for new values base models. Contributes to developing solutions to operational gaps. Monitors value base model performance to identify opportunities to enhance model design based on internal and external feedback and performance data. Experience in Medicaid and Medicaid managed care.

Requirements

Strong interpersonal communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
Attention to detail.
Willing to travel to outlying clinics as needed.
Excellent communication skills.
Knowledge and fluent skills of Microsoft Office Excel and Word applications, internet explorer usage, and Outlook.
Associate's Degree Nursing (ADN)NM and/or a compact state. In lieu of RN license, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
4+ years of healthcare experience
2+ years of experience in provider-facing interactions
Experience and proficiency using Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel spreadsheets.
Ability to review clinical data and provide recommendations for improvement
75% local travel and valid NM Driver's License
Minimum of three years' experience in managing care operations, provider reimbursement and analytics and value-based care

Nice To Haves

Bachelor of Science in Nursing (BSN)
2+ years of experience in HEDIS/STARS, preferably in a clinical quality consultant role
Billing and CPT coding experience
2+ years of data analysis and/or quality chart review and abstraction
Medicare and/or Managed Care experience

Responsibilities

Drive consistency, efficient process and share best practices, in a collaborative effort with the provider and large or complex groups, designed to facilitate a minimum 4 stars quality performance.
Participate in quality improvement initiatives.
Attend monthly or joint operating committee meetings and develop recommendations for quality improvement.
Responsible for quality performance in their assigned region and will work collaboratively with the market team and their leadership in a matrix relationship.
Analyzing financial, utilization and performance data to identify opportunities to drive improvement in quality and/or reduction in total cost of care.
Completes scorecard creation and reconciliation of provider performance based on contractual terms
Analyzes utilization data to reconcile providers disputes
Design and contribute to the development of provider reporting packages to help providers understand their overall performance
Partners with finance team to conduct impact analysis and modeling for new values base models.
Contributes to developing solutions to operational gaps.
Monitors value base model performance to identify opportunities to enhance model design based on internal and external feedback and performance data.