Experience Inc. Jobs

The Care Coordinator and Quality Specialist work in collaboration and continuous partnership with patients and their family / caregiver(s), medical providers, clinics, hospital, and staff as well as community and insurance resources in a team approach to promote timely access to care, increase utilization of preventative care, reduce emergency room utilization and hospital readmissions, and connect patients to relevant resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction, and reducing health care cost. Additionally, the Care Coordinator and Quality Specialist monitor, inspect, and manage services provided by the providers to ensure that reporting efforts related to quality payment programs meet the regulatory and compliance requirements of their respective programs.

Essential Functions

· Provides a positive and professional representation of the organization while managing daily operations to ensure the highest quality care, patient satisfaction, regulatory compliance, and meeting the needs of patients.

· Assist patients in problem solving potential issues related to health care system, financial or social barriers.

· Under the direction of the provider, work with patients to remind and review their care plan and progress towards their goals, increase utilization of preventative services, provide relevant self-management support for chronic conditions, communicate diagnostic results, instructions, and recommendations, and close care gaps to improve patient outcomes.

· Supports staff in collaborating with health plan and other agency representatives to review and identify performance improvement opportunities from providers’ clinical quality performance reports.

· Monitors key internal and external clinical quality metric reports, provider dashboards, and other performance driven reports reporting discrepancies, quality metric performance, workflow-based barriers to AVP, Operations to assist with evaluation of a strategic approach and system redesign for systemic improvement.

· Work in collaboration with clinic providers, staff, care coordinators, and leadership to achieve quality metric improvements, educational opportunities, and performance-based issues.

Non-Essential Functions/ Marginal Duties

All other duties as assigned

Required Skills

Skills:

· Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal and nonverbal

· Knowledge of CMS Stars, HEDIS, CCM, TCM, ACO, MIPS clinical quality measures and healthcare metrics

· Acknowledges patient’s rights on confidentiality issues, maintains patient confidentiality at all times, and follows HIPAA guidelines and regulations

· Proactively acts as patient advocate, responding with empathy and respect to resolve patient and family concerns, and recognizes opportunities for improvement to meeting patient concerns

· Proactively continues to educate self on providing quality care and improving patient concerns

· Participates in planning, implementing, and monitoring continuous quality improvement

· Critical thinking skills with the cognitive ability to understand and analyze complex data using quality measure logic.

Required Experience

Job Requirements

Minimum Education: Graduate of an accredited nursing or medical assistant program

Work Experience: Minimum of 3 years in clinical setting

Required License: Basic Life Support Certification. For LPN or RN, current Kentucky or Multi-State License