• Job Description

  Req#: SENIO002217

  People. Passion. Purpose.

  At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.

  We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.

  We are looking for a Senior HEDIS Quality Coordinator. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.

  Overall Purpose:

  The Senior HEDIS Quality Coordinator supports the regional quality team under the direction of the local leadership. Through provider and patient engagement, the Senior HEDIS Quality Coordinator ensures members are re-aligning with clinic-based care, making sure members have the health care experience they deserve. This position conducts data mining as well as planning, implementing, and executing quality improvement projects.

  The Quality Management team ensures compliance with policies and procedures as dictated by but not limited to the following: Centers for Medicare and Medicaid Services (CMS), the National Committee on Quality Assurance (NCQA), and respective health plans.

  Education and Experience:

  • Associate degree in related field or equivalent experience required
  • 4+ years health care related experience required, managed care experience preferred
  • Medical Assistant certification preferred
  • Pharmacy Technician certification preferred

  Knowledge, Skills and Abilities:

  • Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA
  • Knowledge of federal, national, state, and health plan regulatory requirements, as well as managed care and health plan standards
  • Strong analytical and critical thinking skills
  • Excellent interpersonal and communication skills with patients, providers, internal and external stakeholders
  • Excellent organizational and time management skills
  • Depending on education and experience - demonstrate knowledge of vital signs and other clinical skills related to direct patient care for quality gap closure

  Essential Functions:

  • Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA
  • Provides support to the Quality Management Department by working with members and network providers to improve quality of care through quality activities such as HEDIS, CMS Star Rating, and other quality performance reporting
  • Helps to realign members with clinic-based care on a population-based level
  • Improves patient experience and transitions for better healthcare outcomes through quality care
  • Participates in data collecting through medical record and claims surveillance
  • Onboards, trains, and audits Quality Specialists
  • Works to maximize health plan and healthcare provider performance on healthcare related quality measures through effective telehealth communication with patients and coordination with patient caregivers, providers, and pharmacies.
  • Assists in planning, implementing, and executing projects to improve quality and delivery of care services
  • Using research and knowledge, identifies potential interventions to improve quality strategies
  • Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other opportunities for improvement of healthcare performance measure related issues
  • Participates in Quality Management meetings and other initiatives
  • Prepares quality information for presentation to affiliate groups, including groups current standings relative to others and opportunities for improvement
  • Point of Contact for provider groups designated by Quality Improvement Manager
  • Leads project management of Quality Fairs, Diabetic Days, and P3 events to maximize quality gap closure
  • Subject Matter Expert in P3 machines (diabetic eye camera, bone density machine, etc.)
  • Responds to health plan, provider and interdepartmental calls in accordance with exceptional customer service
  • Reviews provider group gap uploads through the P3 Health Hub
  • Partners with National Quality to creates and maintain departmental SOPs
  • Actively takes lead to make P3 Medical Group the premier medical group in Quality (this may not be reasonable in other markets)
  • Other duties as assigned

  Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

  The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

• About the company

  P3 Health Partners is TRANSFORMING HEALTHCARE. We support healthier patients and communities. Driven by people, with passion and purpose—That’s the power of P3. P3 is a leader in population health management because we embrace a care model and patient ...

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