Quality & Value Clinical Specialist

Day (United States of America)

900 HOPE WAY

ALTAMONTE SPRINGS

Florida

32714

Utilizes data from multiple sources to identify patients with upcoming appointments and conducts thorough chart reviews to determine patient-specific opportunities around open orders, care gaps, coding, medication management, and annual wellness visits. Outreaches patients to complete health risk assessments, follows up on open orders, reviews medications, assesses social determinants of health, schedules/reschedules appointments as needed, and attempts to obtain any outside records for care gap closure and continuity. Contacts patients and families to evaluate their status following discharge from an emergency department or hospital, ensures transitional care management follow-up care is highly coordinated within appropriate time frames, obtains discharge records, calculates LACE scores, reconciles medications, and reviews symptoms. Documents in the upcoming patient encounter all necessary information relevant to the appointment, including suspect conditions, screenings, specific care gaps to be addressed at the visit, initiates orders as needed, updates health maintenance topics, and provides any other key information obtained in the pre-visit planning stage. Answers patient questions within scope and relays other questions and pertinent information by taking accurate messages and routing to appropriate clinical staff. Abstracts records and follows the appropriate process to notify the health plan of documentation for HEDIS care gap closure and other specific program measures. Addresses barriers to care and assists as needed to connect patients and practices to additional internal and external resources, including pharmacy, care management, health plan, and other available programs. Understands strategy to meet program objectives, helps identify performance improvement opportunities, and ensures practices are equipped with pertinent information and tactics to meet goals. Maintains knowledge of practice workflows and coordinates with clinical trainers on best practices. Participates in meetings with payers, practices, and cross-functional teams. Manages and monitors staff productivity levels, quality of output, and resolves workplace-related issues to promote continuous performance improvement. Provides training to team members and oversees efficient departmental operations. Performs other duties as assigned.

$19.22 - $35.75

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.