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Quality Care Coordinator in Orange at Prospect Medical Systems

Date Posted: 7/10/2018

Job Snapshot

Job Description



Quality Care Coordinator

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Quality Care Coordinator (QCC) assists the Performance Programs department leadership team in accomplishing the highest percentage of member compliance for the annual goals of HEDIS, IHA, and STAR measures, as well as Annual Wellness Visits.  Using Cozeva, the QCC will enter data from medical record review, document conversations held with members or healthcare providers, and review data on reports.  The QCC runs patient population due reports from Cozeva (or similar platform) and organizes the data in preparation for member outreach. Through a combination of mailing patient due letters or education flyers, calling the patient and/or healthcare provider, creating referrals, and conducting warm-hand offs; the QCC is the professional representative of striving for patient satisfaction. The QCC is also responsible for providing general health education related to the quality measures showing “due”, as member outbound or inbound calls are conducted. In addition, the QCC goes the extra mile to ensure that the member gets scheduled with a healthcare provider for quality measures “due”. 



Job Responsibilities/Duties

  • Manage assigned member outreach (appointment reminder calls, quality measures due, annual wellness visits, follow-up calls, etc.) by conducting telephone calls to members for all lines of business, to close gaps in care and increase HEDIS/IHA/STAR scores.
  • Receive inbound calls from members and assist with scheduling, etc.
  • Document detailed conversations with member/healthcare provider in Cozeva’s communication module for accurate tracking.
  • Provide general education to encourage the member to complete the required, “due” quality measures.
  • Assist the members by placing 3-way calls to health care providers to get the members scheduled for quality measures showing “due.” 
  • Input referrals.
  • Check Labcorp Beacon daily for incoming FOBT results and fax the lab results to the member’s assigned PCP office. 
  • Assemble and mail FOBT kits. 
  • Facilitate member lab requests, such as developing lab requisitions on Labcorp’s website for appropriate quality measures “due”. 
  • Provide the member with the nearest contracted Lab location to have lab services rendered.
  • Facilitate transportation. 
  • Conduct warm-handoffs to internal departments, as needed.
  • Receive incoming calls from healthcare providers and assist with providing answers to questions regarding Cozeva usage, correct coding for quality measures, provider incentive program, patient assessment survey, or other general information related to company operations. 
  • Accurately enter all data from medical record review, into Cozeva’s supplemental data module. 
  • Enter lab results data accurately into Cozeva’s supplemental data module. 
  • Request medical records from healthcare providers to verify services were rendered, per member’s verbal reporting.
  • Follow all departmental Policies and Procedures for audit compliancy.
  • Mails welcome packets or any other needed information to members for all lines of business.
  • Mails birthday cards and welcome baby cards.
  • Obtains member contact information (email, cell phone, care giver phone, etc).
  • Assists outside departments with facilitating PCP transfers, answering questions, and conducting follow-up calls; as needed.
  • Populate database with new member demographic information.
  • Make outbound calls to contracted offices that show decreased patient satisfaction scores after training.
  • Helps with special projects, as needed.


Qualifications

Minimum Education: High School Diploma or General Education Development (GED) required. 

Minimum Experience: A minimum of one plus (1+) year/s of IPA/HMO experience in P4P/HCC/CMS Star Programs. Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone while maintaining a professional demeanor.

Req. Certification/Licensure: None.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance


How to Apply

To apply for this role, or search our other openings, please visit   http://pmh.com/careers/  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

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