<p>The Quality Care Coordinator (QCC) assists the Performance Programs department leadership team in achieving the highest percentage of member compliance for the annual goals of HEDIS, IHA, and STAR measures, as well as Annual Wellness Visits. The QCC engenders a culture of continuous quality improvement and innovation that enhances patient health outcomes as well as patient, provider, and practice staff experience. The goal of the QCC is to improve the quality and cost effectiveness of the delivery of health care by providing resources to assist with quality improvement activities, encouraging strong patient and clinician partnership, enhancing the care choices of physicians, other providers and patients, and leveraging care tools and systems. The QCC serves as the main quality contact and resource for assigned practices, taking ownership in practice and provider engagement and participation in quality programs and quality improvement activities.</p> <p>The QCC executes population health reports, at the practice, provider, and/or patient level from available population health and/or analytics platforms (such as Cozeva) and organizes the data in preparation for practice staff and provider education and member outreach Member outreach is conducted through a combination of mailing patient due letters or education flyers, calling the patient and/or healthcare provider, and assisting with scheduling activities. The QCC is the professional representative of the quality team and strives to provide a high level of practice and patient satisfaction. The QCC is also responsible for providing general health guidance related to the quality measures showing "due", as member outbound or inbound calls are conducted. In addition, the QCC goes the extra mile to ensure that the member gets scheduled with a healthcare provider for quality measures "due".</p> <ul> <li>Gathers and manages quantitative and qualitative patient data using EHR population registries and evidenced-based assessment tools </li><li>Prepare, modify, and distribute patient data and reports received from external organizations, such as payers, for practice use </li><li>Learns and understands Primary Care practice workflows with respect to optimal and coordinated health care for target patient populations </li><li>Develops a keen understanding of the needs of assigned primary care practices </li><li>Manages patient data collection and generates reports that are convenient for analysis and meet both CPGRI and practice requirements </li><li>Conducts timely outreach tailored to meet each patient's condition specific needs </li><li>Review medical records and other healthcare data sources, and outreach to other facilities and/or providers to obtain patient records, results or reports for quality gap closure. </li><li>Serve as a liaison between providers, office staff, patients and insurance plans. </li><li>Communicate with office managers regarding patient gaps in care and provide support to meet quality care metric goals that is individualized for each practice. </li><li>Provide in-office support and training to office managers and/or providers as it relates to quality </li><li>Knowledge and ability to access ExactSciences for reports, and fax orders requested for Cologuard assigned by PCP office. </li><li>Keep open line of communication within the QCC Team to ensure all efforts are on coordinated on open gaps, quality care of patients and effective outreach. </li><li>Meaningfully participate in weekly Team meetings with other QCCs and quality management staff to review/set goals and workflow for best outcomes </li><li>Support practice staff to develop creative processes to proactively manage target populations and provide data support and quality education when applicable </li><li>Work closely with the Networking Team to ensure all CRC news, upcoming events, and best practices are communicated/delivered to assigned QCC practices. </li><li>Accurately upload all data from medical record review, into Cozeva's supplemental data module. </li><li>Attend in-person and/or virtual quality related meetings </li><li>Conduct quality improvement projects in collaboration with assigned primary care practices </li><li>Follow all departmental Policies and Procedures for audit compliancy. </li><li>Respond to inquiries from designated practices in a timely manner </li><li>Other duties as assigned. </li></ul> <p>Education/Experience:</p> <ul> <li>High School Diploma or General Education Development (GED) required. </li><li>Basic understanding of medical terminology. </li><li>Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone and in-person while maintaining a professional demeanor. </li><li>Preferred minimum of 2 years experience in customer service or in a health care setting. </li><li>Experience in promoting healthcare behavior change is desirable </li><li>Proficient in data management and reporting. </li><li>Proven problem-solver with ability to multi-task </li><li>Prior use of electronic health records and other health care information systems desirable </li></ul> <p>Knowledge/Skills/Abilities:</p> <ul> <li>Ability to identify problems, think creatively, and devise innovative solutions </li><li>Strong verbal and non-verbal communication skills required. </li><li>Highly organized, self-directed and able to accomplish daily workflows in remote, central office and practice-based settings </li><li>Ability to work as a member of a collaborative team and engage others in efforts towards accomplishing objectives </li><li>Ability to manage and complete assignments with minimal supervision or absence of detailed instruction. </li><li>Proficiency in Microsoft Office Suite, included but not limited to Excel, Outlook, and Teams applications. </li><li>Knowledge of P4P database, such as Cozeva and Cerner. </li><li>Bi-lingual (Spanish, Portuguese, Cape Verdean and/or French Creole, French, Chinese, etc. welcomed. </li><li>Must be able to speak, read, and write English proficiently. </li><li>Strong verbalization skills; ability to provide information to respond to questions from managers, peers, physicians, members, and the general public. </li><li>Demonstrate a strong commitment to our company's values: Integrity, Ambition, Smart, Passion, Accountability, and Teamwork. </li></ul>