Clinical Quality Coordinator (RN)
About the role
Educate members about needed screenings, including diabetic and breast cancer screenings. Encourage members to schedule appointments and assist with scheduling as needed. Complete assessments, including the Conditions of Older Adults assessment, to review members' independence, fall history, and need for physician follow-up. Adapt to changing outreach campaigns, priorities, and processes. Work from home in the Eastern or Central time zone. Approximately 8:00 a.m.-5:00 p.m., with adjustments based on your time zone and business needs.
Position Purpose: Conduct member outreach, provider outreach, and chart review to assess, plan, gather information, and coordinate medical and supporting services across the continuum of care to support both direct and indirect HEDIS care gap closure.
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary support care gap closure activities.
- Provide patient and provider education
- Facilitate member access to community based services
- Identify related risk management quality concerns and report these scenarios to the appropriate resources.
- Support direct care gap closure of HEDIS measures through member outreach, assessment, and documentation of member status.
- Provide clinical support as needed to outreach coordinators interacting with high-risk members and/or providers to improve healthcare outcomes and close care gaps. Provides support for quality initiatives including outreach to members who are noncompliant in the designated outreach services.
- Maintain a caseload of members to provide education to members/guardians to support improved healthcare outcomes and see them through care gap closure activities, such as childhood immunizations.
- Performs other duties as assigned
- Complies with all policies and standards
Education/Experience
Not included in the source posting: about the role, benefits.
Who can apply
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