Company Statement
Careers at AdvantageCare Physicians: At AdvantageCare Physicians, our providers and care teams reflect our commitment to population health. Improving the health of our patients is our goal; keeping our patients healthy is our commitment. Using our state-of-the-art electronic medical record (EMR) system, our providers, care teams, and practice administration staff work together to deliver high-quality, comprehensive and convenient care to our patients.
To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
Quality Specialist - Hybrid
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- Patient Services
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- Aug 27, 2024 Post Date
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- 1000002064 Requisition #
Summary of Position
• Provide outreach to patients to support HEDIS (Health Effectiveness Data and Information Set), HCC (Hierarchical Conditions
Category), and other quality improvement initiatives implemented to manage population health across all contracted ValueBased Payors.
• Support additional quality and care coordination, HEDIS and HCC related projects/programs including but not limited to
identifying information in the medical record to support gap closure and communicating HEDIS related information to clinical
and administrative staff in the medical offices.
Principal Accountabilities
• Outreach patients telephonically and digitally to schedule appointments including identifying barriers to patient
engagement in making and keeping appointments required to provide appropriate medical care and close HEDIS/HCC
gaps.
• Communicate barriers/ issues to leadership as they present for direction/resolution.
• Maintain productivity metrics required for Charts Reviewed and Appointments Scheduled to review/outreach all
patients assigned.
• Review patient’s chart as needed to determine outreach requirements based on quality and operational strategy
guidelines, processes and workflows.
• Determine next steps based on chart review findings.
• Present complex chart review findings to management for review/ determination of next steps.
• Conduct work essential to supporting outreach efforts, including but not limited to:
• Collect and verify compliance data for reporting and gap closure.
• Document as appropriate, outcome of outreach in EPIC.
• Support all care coordination initiatives based on quality efforts.
• Participate in departmental and corporate meetings and trainings.
• Perform other job-related duties as required.
• Understand and apply HEDIS/HCC specifications to determine next steps as it relates to compliance status and
outreach for our contracted value-based patient population.
• Determine possible cause of issue affecting patient compliance.
• Present issue and possible solution(s) to management for review/ resolution.
Note: There are two roles available
Education, Training, Licenses, Certifications
• High School diploma/GED (R)
• Bachelor’s Degree Preferred (P)
Relevant Work Experience, Knowledge, Skills, and Abilities
• Minimum of two years’ experience in health care setting (R)
• Excellent interpersonal, communication, organization and writing skills with the ability to effectively prioritize work. (R)
• Ability to adjust quickly to change (R)
• Commitment to enhancing patient experience. (R)
• Computer proficiency, with Microsoft Office applications including Word, Excel. (R)
• Knowledge of HEDIS quality measures. (P)
• Minimum of two years’ experience in quality related activities. (P)
• Knowledge of utilizing electronic medical records systems (such as EPIC). (P)
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.