Population Health Quality Review Specialist

Vanguard Health Solutions is actively seeking a Quality Review Specialist to join our Population Health team in Verona, NJ.

As a Quality Review Specialist, you will be responsible for supporting primary care teams, playing a key role in improving compliance on population health initiatives. Your role, embedded within a primary care office, focuses on tasks such as validating data, coordinating patient outreach, and managing data in Excel. While this position does not involve direct patient care, it offers a valuable opportunity for those interested in or pursuing a career in the healthcare industry. The role is based in the Verona, NJ office and may require onsite meetings.

Essential Functions/Responsibilities:

• Data Validation:
  • Utilize electronic health records and population health management systems for data validation.
  • Transfer patient data regarding quality care gaps from clinic medical records to VMG population health management platforms.
• Patient Outreach and Campaigns:
  • Proactively work payer care gap reports for all VMG value-based lives.
  • Perform patient outreach to schedule visits for campaigns such as annual wellness visits, physicals, breast cancer screening, and colorectal cancer screening.
• Documentation and Reporting:
  • Document patient outcomes and track work efforts within Microsoft Excel.
  • Regularly review patient charts for screening needs and quality gap closure within Microsoft Excel.
• Order Placement and Coordination:
  • Under the appropriate physician licensure, use standing orders to place orders for screening and quality gap closure needs.
• Collaboration and Compliance:
  • Conduct medical records requests from various health insurance payors.
  • Verify relevant coding in patient visit notes onto a population management platform.
  • Collaborate effectively with the primary care team and VMG clinical performance teams.
• HIPAA Compliance and Mastery:
  • Adhere to all HIPAA guidelines and policies.
  • Maintain mastery in various population health initiatives.
• Technology Integration:
  • Willingly work with new technology, including patient portals.

Requirements:

• Associates or Bachelors degree (Preferred) in healthcare, human services, or a related field or equivalent work experiences.
• Minimum 2 years of experience in healthcare or human services preferred.
• Knowledge of and experience with clinical quality process improvement concepts preferred.
• Excellent motivational skills to assist patients in achieving healthy outcomes.
• Experience in Microsoft Office applications, including Word, Excel, PowerPoint, required.
• Passionate about customer service and patient satisfaction.
• Courteous, empathic, and professional manner.
• Strong communication, interpersonal, and organizational skills.
• Receptive to feedback, willing to learn, embracing continuous improvement.
• Detail-oriented, problem-solving, and organizational skills.
• Ability to work independently and in a team environment.