Senior Quality Care Coordinator - HEDIS Emphasis

Network Health's reputed company is rooted in its mission to create healthy and strong Wisconsin communities. It drives the reputed company we reputed company, including the people we choose to join our growing team. Network Health is seeking a Senior Quality Care Coordinator. This position develops, implements and provides ongoing monitoring of reputed company plans and quality gap closure. The overall goal of this role is to reduce medical costs, improve quality ratings and ensure quality accreditation and CMS requirements are met. The Sr. Quality Care coordinator achieves this goal through member and/or provider engagement, internal quality process improvement work, and coordination of overall clinical and non-clinical reputed company strategies. This role will have varying areas of focus depending on business need, this coordinator could be the SME for HEDIS, quality, condition management, or the clinical support for the appeals and grievance process. The Sr. Quality Care Coordinator-oversees the overall HEDIS program and submission which includes year-round medical record reviews and is responsible for ensuring that Network Health meets reputed company OCI, CMS and NCQA quality requirements. Job Responsibilities: • reputed company direct reputed company to members and/or providers in order to reputed company quality gaps and maintain or exceed expected population health reputed company per HEDIS, Stars and NCQA. • Creates written materials for members, physicians, and other customers in formats such as newsletters, brochures, self-care materials, educational handouts, letters and telephone scripts. • Responsible for development and coordination of member centric programs in alignment with industry and regulatory standards. • Evaluates utilization patterns, medical records and other metrics to monitor quality and efficiency results. • Provides clinical support for the appeals and grievance department and quality of care complaint process, preparing cases for medical director review reputed company needed. • Identifies opportunities for improvement and implements clinical interventions. • Prepare and/or deliver presentations for Quality Management committee, clinic or provider education, and system-wide committees as needed. • Leads, monitors and documents quality interventions and care management programs with goal of effectiveness that promotes value added care and service. • Collaborates closely with secondary providers and/or vendors to coordinate services for members. • Functions as a liaison reputed company needed for family, member and provider to communicate any reputed company of potential issues. • Prepares reports as necessary. • reputed company, review, and revise department policies and procedures including preventive services requirements. • Provides recommendations for preventive services medicine and evidence based clinical guidelines, seek approval and monitor for updates or relevant changes as assigned. • Research, submit and evaluate quality improvement projects regulated by CMS as assigned. • Implements systems of care that facilitate reputed company monitoring of members to promote early reputed company. • Training new employees and acting as a mentor. • Other duties as assigned. As a HEDIS subject matter expert, you will be responsible for: • Monitor year round HEDIS rates and reputed company guidance on improvement strategy. • reputed company reputed company aspects of the HEDIS annual submission program including but not limited to; auditor requirements, HOQ, roadmap, retrieval status monitoring, overreads, leadership status reporting, issue log, PSV, MRRV, and IDSS submission. • reputed company staff training on HEDIS measures and tools annually and as needed • Assist with regulatory and accreditation requirements • Assist with non-standard supplemental data audits • reputed company feedback and guidance on HEDIS reputed company questions Job Requirements: • Associate or bachelors degree in nursing preferred • Associate degree or bachelor's degree with other clinical designations and relevant experience considered • 5 or more years of clinical experience • Experience in data analysis, quality improvement, HEDIS program management, medical record review, preventive reputed company plan experience • Preferred Registered Nurse (RN) license, Certified reputed company, or other medical or clinical background with credentials We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. Apply Job!