Clinical Quality Specialist

The Hybrid Clinical Quality Specialist (QS) will focus on quality data performance through care gap closure and monitoring of provider data and HEDIS metric compliance. The QS will be responsible for communicating with providers and physician partners on quality improvement initiatives and collaborating with physician partner’s Quality Lead.

The Quality Specialist (QS) will focus on quality data performance through care gap closure and monitoring of provider data and HEDIS metric compliance. The QS will be responsible for communicating with providers and physician partners on quality improvement initiatives and collaborating with physician partner’s Quality Lead.

Essential Job Functions:

• Responsible for daily expectations and goal achievements centered around care gap closure and metric performance through the reporting and direction of the local physician group’s Health Informatics reporting tools as well as the Senior Health Connect teams and agilon platforms.
• Manage metrics and care gap processes under review.
• Assist the providers and site staff of the local physician group as well as the teams of the Senior Health Connect group in obtaining and dissemination of quality reporting for center meetings.
• Work in collaboration with local physician group and Senior Health Connect team for practice operations workflow improvements.
• Communicate observations to the physician partner and Senior Health Connect team.
• Review payor reports for identification of care gap closure and metric performance opportunities. Quantify trends and regional reports for monthly review.
• Implement Quality action plans with partner group.
• Maintains and monitors process to track Stars progress monthly.
• Support ongoing requirements for provider education to improve quality performance.
• Support care management quality initiatives as directed including monitoring of utilization trends using agilon hub tools including progress on active panel management program.
• Establish and maintain cooperative and collaborative working relationships with coworkers and administrative team and physicians/providers of physician partner and Senior Health Connect team.
• Visit physician offices as directed to conduct education and hold continuous discussions around data and workflows.
• Understand and utilize all health information systems as required by physician partner to support Senior Health Connect quality performance.
• Complete all appropriate documentation.
• Maintain patient confidentiality.
• Perform other duties as required.

Other Job Functions:

• Understand, adhere to, and implement the Company’s policies and procedures.
• Provide excellent customer services skills, including consistently displaying awareness and sensitivity to the needs of internal and/or external clients. Proactively ensuring that these needs are met or exceeded.
• Take personal responsibility for personal growth including acquiring new skills, knowledge, and information.
• Engage in excellent communication which includes listening attentively and speaking professionally.
• Set and complete challenging goals.
• Demonstrate attention to detail and accuracy in work product.

Required Qualifications:

Minimum Experience

• Experience in medical coding, office practice management, process management, and HEDIS.
• Experience in Quality initiatives and metrics performance.
• Must be able to work flexible hours.
• Must demonstrate proficient computer skills. Previous EMR (epic/healthy planet) preferred. Excel experience is required.
• Must be able to work independently and as part of a team.

Education/Licensure:

• Bachelor’s degree or 1-3 years of equivalent experience with emphasis in business administration or healthcare.