JOB SUMMARY
The Quality Specialist II helps to ensure True Health provides the highest quality of services to their patients. This position addresses basic and complex support needs of the individual patient and assists in coordination of the therapeutic aspects of the services provided. This coordination will close care gaps for patients through education, monitoring, and advocating for individuals in conjunction with direct care providers.
PRIMARY FUNCTIONS
- Plan with the patient, family/caregiver, primary care provider, support staff, payers, and the community resources, to maximize healthcare responses, quality, and cost-effective outcomes.
- Facilitate communication and coordination between members of the healthcare team, involve the patient in the decision-making process to minimize fragmentation in the services.
- Educate the patient, family or caregiver, and members of the healthcare delivery team about treatment options, community resources, psychosocial concerns, care coordination, etc., so that timely and informed decisions can be made.
- Empower the patient to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes.
- Encourage the appropriate use of healthcare services and strive to improve quality of care and maintain cost effectiveness on a case-by-case basis.
- Assist the patient in the safe transitioning of care to the next most appropriate level.
- Strive to promote patient self-advocacy and self-determination.
- Attending monthly meetings with insurance payers to have a consistent line of communication open and assist with setting goals for quality improvement.
- Work on projects as assigned based on priorities received from insurance companies and internal quality metrics.
- Stay involved and active with quality improvement activities.
- Conduct chart audits to determine quality compliance and documentation opportunities
- Proficient in clinical knowledge to aid other non-clinical colleagues with closing care gaps as needed.
- This is a remote position
- Other projects/duties as assigned
EDUCATION AND EXPERIENCE
- Current Florida LPN License, active and in good standing, preferred
- Certified Medical Assistant active and in good standing, considered
KNOWLEDGE, SKILLS, AND ABILITIES
- One (1) year minimum experience in Clinical Care Coordination
- One (1) year minimum experience with an EHR
- One (1) year experience in Quality &/or HEDIS
- Expierence working in the clinical environment such as provider office
- Computer competency is required
ADDITIONAL QUALIFICATIONS
- Bilingual is a plus (English/Spanish)
- Must be a collaborator but able to work independently
- Excellent spoken and written communications skills
- Must have reliable transportation
RELATIONSHIP REPORTING
- Reports to Quality Manager
PHYSICAL REQUIREMENTS
- Ability to view a computer screen for extended periods of time
- Ability to perform repetitive hand and wrist motions for extended periods of time
- Ability to communicate effectively with patients and staff
- Ability to sit, stand, walk, or view computer screen for extended periods of time
- Ability to use hands and fingers to handle or feel
- Ability to reach with hands or arms
- Ability to perform repetitive hand or wrist motions for extended periods of time
- Ability to effectively talk and listen to patients and co-workers