Quality Specialist Ambulatory – Managed Care

Job description

Silver Cross Hospital is an extraordinary place to work. We’re known for our culture of excellence and delivery of unrivaled experiences for our patients, their families, the communities we serve…and for each other. Come join us! It’s the way you want to be treated. Position Summary : Position will be responsible for creating, implementing, and maintaining a vision and plan for providing improved quality clinical outcomes to patients in the private practice setting, in collaboration with the Senior Leadership team. We will work with all practices of SCHC on closing care gaps, helpings practices, hospital, and ancillary sites in coordinating patients’ care plan, and work side by side with clinical leadership in creating Quality strategy moving forward. Essential Duties and Responsibilities : Subject matter expert regarding the HEDIS product line Represent the Clinical Integration product for both client and internal business process meetings Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service The position works closely with the Chief Medical Officer to ensure effective clinical, quality, and medical management operational processes and policies that align with targeted quality outcomes and goals for enrollees Promotes linkage between utilization management, care coordination and quality improvement activities with partnered MSO Acts as a role model for clinical staff, promoting education, development and adoption of practice transformation with focus on clinical workflow, member satisfaction, improved RAF scoring Promotes collaboration while working closely with Director Value Based Care and Innovista, in conjunction with maintaining appropriate communication with CMO and Senior Leadership Development, and implementation of Policies and Procedures for Clinical Operations in the clinical office setting Responsible for oversight of clinical training activities and outcomes. Required Qualifications : Education and Training : A minimum of an Associate’s degree in nursing and two (2) years of experience in clinical documentation improvement or inpatient coding, OR Excellent verbal, written, presentation, computer, and interpersonal communication skills. Highly Desired: ICD-10-CM/PCS Coding training and certification 3-5 years clinical practical experience 2-3 years CM, discharge planning and/or home health care coordination experience Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Ability to work independently (remote working). Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications. Efficient and Effective computer skills including navigating multiple systems and keyboarding Licenses/Certifications Required: Currently licensed as a Registered Nurse (RN) Work Shift Details: Days, Days Department: CLINICAL DOCUMENTATION Benefits for You At Silver Cross Hospital, we care about your health and well-being and that is why we work hard to provide quality and affordable benefit options for you and your eligible family members. Silver Cross Hospital and Silver Cross Medical Groups offer a comprehensive benefit package available for Full-time and Part-time employees which includes: · Medical, Dental and Vision plans · Life Insurance · Flexible Spending Account · Other voluntary benefit plans · PTO and Sick time · 401(k) plan with a match · Wellness program · Tuition Reimbursement Registry employees who meet eligibility may participate in our 401(k) Savings plan with a potential match. However, registry employees are ineligible for Health and Welfare benefits. The expected pay for this position is listed below: $35.76 - $45.60 The final pay rate offered may be more than the posted range based on several factors including but not limited to: licensure, certifications, work experience, education, knowledge, demonstrated abilities, internal equity, market data, and more.