Address
Form of work GENERAL SUMMARY:
The Quality & Value Clinical Specialist will focus their efforts on planning for upcoming patient appointments to improve Quality and make value capture easy for Primary Care providers. They will identify patient populations for pre-visit planning with an emphasis on annual wellness visits, transitional care management services, care gap closure, risk adjustment, medication adherence, and patient experience. The QVCS will partner with health plans, Primary Care practices, and collaborate with multidisciplinary teams across AdventHealth to support key strategic improvement activities that drive whole-person care.
Schedule: Monday-Friday; 8am-5pm
Address: Remote - Individuals must be located in the Greater Orlando, Daytona or Tampa Metro area
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES :
• Utilizes data from multiple sources to identify patients with upcoming appointments and conducts a thorough chart review 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 SDOH, 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 ED or hospital and ensures TCM 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.
• Performs other duties and tasks as assigned.
Qualifications
KNOWLEDGE AND SKILLS REQUIRED:
• Knowledge and understanding of chronic and acute disease conditions
• Proficient in Microsoft Office, PowerPoint, Word, and Excel
• Excellent communication skills, both verbal and written
• Knowledge and understanding of value-based care concepts
• Proficient at learning and working in multiple computer systems
• Skilled at preparing records and responding to correspondence
• Flexibility in prioritization and highly organized
• Ability to build relationships and collaborate with multidisciplinary teams
• Self-motivated with strong critical thinking abilities
KNOWLEDGE AND SKILLS PREFERRED:
• Knowledge and understanding of CDI, RAF and HCC coding
• Knowledge and understanding of HEDIS and CMS Star rating measures
EDUCATION AND EXPERIENCE REQUIRED:
• Graduate of a nursing or medical assisting program
• 3 years of healthcare experience
• Epic or other EMR experience
EDUCATION AND EXPERIENCE PREFERRED:
• Advanced degree in healthcare and/or medical billing coding
• Greater than 3 years of healthcare experience
• Primary care office experience
• Quality programs experience
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
• Licensed Practical Nurse or Certified Medical Assistant
LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:
Certified Medical Coder (CRC, CPC, CCS, COC)
The Quality & Value Clinical Specialist will focus their efforts on planning for upcoming patient appointments to improve Quality and make value capture easy for Primary Care providers. They will identify patient populations for pre-visit planning with an emphasis on annual wellness visits, transitional care management services, care gap closure, risk adjustment, medication adherence, and patient experience. The QVCS will partner with health plans, Primary Care practices, and collaborate with multidisciplinary teams across AdventHealth to support key strategic improvement activities that drive whole-person care.
Schedule: Monday-Friday; 8am-5pm
Address: Remote - Individuals must be located in the Greater Orlando, Daytona or Tampa Metro area
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES :
• Utilizes data from multiple sources to identify patients with upcoming appointments and conducts a thorough chart review 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 SDOH, 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 ED or hospital and ensures TCM 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.
• Performs other duties and tasks as assigned.
Qualifications
KNOWLEDGE AND SKILLS REQUIRED:
• Knowledge and understanding of chronic and acute disease conditions
• Proficient in Microsoft Office, PowerPoint, Word, and Excel
• Excellent communication skills, both verbal and written
• Knowledge and understanding of value-based care concepts
• Proficient at learning and working in multiple computer systems
• Skilled at preparing records and responding to correspondence
• Flexibility in prioritization and highly organized
• Ability to build relationships and collaborate with multidisciplinary teams
• Self-motivated with strong critical thinking abilities
KNOWLEDGE AND SKILLS PREFERRED:
• Knowledge and understanding of CDI, RAF and HCC coding
• Knowledge and understanding of HEDIS and CMS Star rating measures
EDUCATION AND EXPERIENCE REQUIRED:
• Graduate of a nursing or medical assisting program
• 3 years of healthcare experience
• Epic or other EMR experience
EDUCATION AND EXPERIENCE PREFERRED:
• Advanced degree in healthcare and/or medical billing coding
• Greater than 3 years of healthcare experience
• Primary care office experience
• Quality programs experience
LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:
• Licensed Practical Nurse or Certified Medical Assistant
LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:
Certified Medical Coder (CRC, CPC, CCS, COC)
