What are the responsibilities and job description for the Provider Engagement Quality Specialist - ACO/PO position at Commonwealth Care Alliance?
- Be the plan conduit to provider practices in Michigan; develop provide educational materials and trainings to increase effectiveness to close clinical gaps in their patient care with CCA membership; use data and reporting to deliver feedback, identify areas of need and communicate to practices opportunities for improvement.
- Contact and work with doctor's office on notification, scheduling, and logistics for completing the review.
- Conduct on-site review and document all quality information from the files reviewed.
- Review reports for audit scope. Research and analyze reports to narrow and define scope for on-site review and review period.
- Work with physician's office staff in obtaining information for completion of reviews and audits.
- Prepare review audit findings and reports identifying, areas of non-compliance and risk areas for non-compliance.
- Manage risk areas for non-compliance with office contacts and provide education, create roadmap to improving compliance with physician, or office staff to reduce risk identified.
- Build relationships with physician's office staff for future activity. Escalate office or relationship issues to CCA ACO Michigan leadership.
- Work with other CCA ACO employees and leadership to obtain, share and suggest information for advancing the mission of the organization.
- Conduct EMR/record searches for audit measures with multiple year look back periods to improve chart capture rates (for instance: colorectal cancer screenings and mammograms)
- Develop strong professional relationships with all providers and their staff while functioning as a liaison to the provider community.
- Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and appreciation events.
- Other duties as assigned.
Working Conditions:
Standard office conditions; more than half of the time, the position will be working in designated primary care practices to support improvement activities.
- Valid Driver's license and reliable insured automobile required
- Must be able to travel within an assigned territory daily
