About this position
JOB SUMMARY: Responsible for coordinating with 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.
- Assists with associated VBC projects (medication adherence review, quality audits, high utilizers, etc.)
- Provides timely follow up on clinical HEDIS performance (through chart and portal audits) and assists in relaying clinical or documentation trends to management
- Triages ED/IP discharge reports for department dissemination based on clinical findings
- Performs transitions of care outreach for ED/IP visits
- Screens patients from clinical outreach, collaborates with CHW for social determinants of health needs
- Facilitates population health education on appropriate use of after hours services.
- Completes outreach, assessments and tracking for Medicare Annual Wellness Visits.
- 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 contracts.
- Proven work record of improving business processes and procedures to maximize efficiency.
- Ability to maintain accurate records and prepare meaningful reports.
Preferred Qualifications:
- 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.
- 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 Microsoft and Google software.
- Strong analytical skills, adept in data mining, data analysis and data presentation.
- Strong quantitative 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 (on-site)
Physical Requirements:
- Prolonged periods sitting at a desk and working on a computer.
- Must be able to handle physical demands of installation of communication system equipment, which may include lifting up to 25 pounds at times.