Job Information
Upper Peninsula Health Plan Clinical Coordinator - PGIP in Marquette, Michigan
Are you passionate about healthcare and eager to contribute in a collaborative and inclusive environment? If you're seeking a fresh start with a focus on work-life balance, consider joining our team as we work towards creating a healthier Upper Peninsula.
We offer a range of benefits designed to support your well-being and professional growth, including:
- No nights, weekends, or holidays
- Generous time off: Vacation, Sick, Volunteer, and Personal Time
- 12 Paid Holidays
- Life and Disability Insurance with no premium cost
- 401(k) with a safe harbor contribution
- Tuition Reimbursement
- Student Loan Repayment Assistance
- Fitness Center Reimbursement
- And much more!
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POSTED: September 18, 2024
POSITION: Clinical Coordinator---PGIP
DEPARTMENT: Clinical Services
FLSA STATUS: Nonexempt
BASE RATE: $24.75 per hour, with potential for additional compensation based on qualifications.
POSITION SUMMARY:
Performs assigned duties and clinical functions in accordance with Upper Peninsula Health Plan (UPHP) plans, policies, and procedures, all state and federal accrediting and regulatory standards and Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information.
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``` 2. Performs all assigned tasks in accordance with UPHP plans, policies and procedures, as well as National Committee for Quality Assurance (NCQA), BCBSM PGIP, and all regulatory standards.
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``` 3. Assists in the development and maintenance of policies and procedures related to PGIP and other assigned programs in accordance with program, regulatory, and accrediting standards.
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``` 4. Prepares reports and educational materials as required and presents reports and educational information via webinars and forums.
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``` 5. Engages with practices to onboard and participate with BCBSM PGIP initiatives. Assists in the development of practice incentive design, as requested.
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``` 6. Conducts onsite assessments with participating practices at least annually to determine BCBSM PGIP initiative progress; this includes scheduling, travel arrangements, onsite assessment, and post assessment follow-up.
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``` 7. Demonstrates knowledge of all BCBSM PGIP requirements; Centers for Medicare and Medicaid Services (CMS) standards; all applicable NCQA standards; and Healthcare Effectiveness Data and Information Set (HEDIS) measures as they relate to clinical functions and respective programs; assumes responsibility for specific NCQA and BCBSM standards as assigned.
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``` 8. Participates in departmental and interdepartmental process improvements; recommends improvements in clinical processes as opportunities are identified.
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``` 9. Participates in internal and external workgroups, collaboratives, and specialized trainings as required by BCBSM and/or UPHP.
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