Quality Coordinator

Clinical healthcare professionals are responsible for managing and monitoring the clinic's performance on quality metrics set by health insurance companies (payers) in order to maximize financial incentives tied to achieving those quality standards, essentially ensuring the clinic is delivering high-quality care to meet the requirements for additional payments from payers. As well as planning for the future growth of the program with Practice Manager.

*Minimum Education:

Licensed Practical Nurse or MA Certified.

*Minimum Experience:

Two Years/Medical Field or a combination of Education and Experience.

Required Skills:

Considerable and frequent mental effort required, primarily in planning/decision making.  Good physical health is required because of extended periods of standing, walking and work required. Occasionally carries up to ten pounds.

Required Licensure or Certification

Licensed Practical Nurse or MA Cert

Leadership Capabilities:

Must be alert to the needs of the staff and lead by example.  Correcting them in a professional manner.

*Essential Functions:

• Tracking quality metrics:
  • Regularly monitor key performance indicators (KPIs) like preventive care rates, chronic disease management, medication adherence, and patient satisfaction, as defined by different payers. 
• Data analysis:
  • Analyze clinical data to identify areas for improvement and trends in quality performance. 
• Provider education:
  • Educate clinicians on quality measures, best practices, and how their actions impact the clinic's overall performance on payer incentive programs. 
• Quality improvement initiatives:
  • Design and implement strategies to improve quality metrics, including clinical workflows, patient education programs, and system changes. 
• Reporting and communication:
  • Regularly communicate quality performance data to clinic leadership, providers, and payers. 
• Payer contract management:
  • Understand the specific quality requirements outlined in payer contracts and ensure the clinic is adhering to them. 
• Understanding value-based care:
  • A deep knowledge of value-based payment models, including pay-for-performance (P4P) and risk-sharing arrangements, is crucial. 
• Data analysis skills:
  • Proficiency in using healthcare data systems to extract, analyze, and interpret quality data is essential. 
• Collaboration:
  • Effective communication and collaboration with clinicians, practice managers, and payer representatives are key to successful quality improvement. 
  • Cover for other nurses as needed.