JOB SUMMARY: Responsible for coordinating
Population Health and Quality clinical projects for Value Based Contracts
including planning, coordination, reporting, and supervision to ensure
performance and quality standards are met.
Responsible for performing ongoing clinical audits for VBC.
Requires working closely with the management
team to coordinate processes between operations.
Responsible
for updating payer spreadsheets to ensure all incentive payments are
recorded in coordination with finance team
Facilitates
all VBC clinical quality audits and provides necessary follow up
information to leadership and/or payer team
Performs
transitions of care outreach for ER/Hospital visits
Screens
patients from clinical outreach for social determinants of health
Facilitates
population health education on appropriate use after hours services
Collaboration
with Community Heath Navigator team as appropriate for SDOH
Provides
timely follow up on clinical HEDIS performance and assists in relaying
clinical or documentation trends to management
Responsible
for completion of work in a timely manner to meet customer expectations.
Maintains
communication with leaders regarding issues involving team operations such
as workflow, services, and client development activity.
Additional
duties and responsibilities as assigned.
Minimum Qualifications:
· Graduate from a nationally accredited school for
practical or vocational nursing
· Current license to practice nursing in the state of
Louisiana
Minimum
of two years clinical data abstraction and auditing experience
Working
knowledge of HEDIS, Transitions of care, and VBC contacts
Proven
work record of improving business processes and procedures to maximize
efficiency.
Preferred Qualifications:
Ability
to maintain accurate records and prepare meaningful reports.
Excellent
time management and organizational skills with the ability to handle
multiple projects, meet established deadlines and change as business needs
require.
Outstanding
interpersonal, customer service, communication and leadership skills with
the ability to work independently as well as part of a team.
Current
working knowledge of the healthcare industry and its practices is
required.
Proven
decision-making skills with the ability to use sound judgment.
Proficient
working knowledge of communications technology as well as a basic working
knowledge of the phone and call software.
Proficient
working knowledge of Word, Excel, Access and working with system
development.
Strong
analytical skills, adept in data mining, data analysis and data
presentation.
Strong
quantitative skills; possesses advanced Excel skills.
Ability
to establish strong partnerships within all levels in the organization
while adjusting communications to the specified audience.
Ability
to communicate complex ideas in clear, succinct terms (written and verbal)
for business and process decisions
Job Type: Full-time
Physical Requirements:
· Prolonged
periods sitting at a desk and working on a computer.
· Must
be able to handle physical demands of installation of telephone system
equipment, which may include lifting up to 25 pounds at times.
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