POSITION SUMMARY:
Under the direction of the MPN Quality Manager the Quality/Population Health Specialist will support performance improvement in Clinical Care/Outcomes, Customer/Service Improvement, Operational System/Process, and Safety. The purpose of this role is to facilitate and maintain improved healthcare outcomes for our patients by providing closure of care gaps and preventative screenings through the use of disease management and health maintenance tools and resources.

POSITION SPECIFIC PERFORMANCE STANDARDS:

• Facilitates completion of Medicare well visits by determining eligibility, pre visit chart review, contacting patient for a comprehensive medical and social review including but not limited to with complete documentation of pre visit encounter
• Past medical and surgical history
• Current medications and supplements
• Family history including hereditary conditions that place individuals at increased risk
• Home safety
• Ability to perform activities of daily living
• Depression screen
• Nutrition screen
• Cognitive screen
• Fall risk assessment
• Screening for advanced care plan or arrange to have information provided
• Health status self-assessment
• Update care team list
• Update demographics
• Retrieves clinical documentation to identify and/or complete care gap closure utilizing every resource available including patient and external facility outreach
• Assists with workflow analysis and identifies opportunities for improvement in the education and learning process and implement strategies to improve clinical excellence and operational efficiencies.
• Proficient in the proper and timely indexing process and document/form quality requirements for all records processed in the EMR.
• Reviews and accurately indexes each document to the correct patient’s medical record, utilizing the correct document naming convention per best practice protocol.
• Manually assigns the correct document code and name if the document does not auto route to an individual chart
• Verifies document is assigned to the correct patient using patient DOB as first identifier and patients name as the second patient identifier.
• Manages the inbound fax tank, renaming and moving to the correct document type in patients chart.
• Assists with transitional care and annual well visit chart preparations.
• Participates in chart audits when applicable and reviews audit findings with the Quality Manager.
• Appropriately collaborates with Best Practice Coordinator on any questions related to patient form/documentation and any quality assurance concerns.
• Communicates relevant discrepancies with the Best Practice Coordinator and coworkers to ensure continuous learning and standardization.
• Demonstrates proficiency in retrieving and entering data into clinical systems including EHR and various payer platforms.
• Analyzes, verifies, tracks and reports on trends data. Extracts patient clinical data from medical records or other sources containing patient clinical data.
• Demonstrates proficiency in maintaining regulatory requirements for HEDIS, NCQA and CMS quality metrics/programs.
• Addresses gaps in care identified by EMR, quality or payer reports.
• Aids in insurance patient attribution utilizing payer patient lists and/or practice requests.
• Develops a relationship with the Ambulatory practices as an extended member of the care team to work towards network goals.
• Identifies and escalates quality of care issues through established channels.
• Exhibits understanding of practice workflows to optimally identify opportunities and assists with quality improvement recommendations.
• Maintains productivity and accuracy standards, accordingly.
• Maintains confidentiality of all materials handled within the Network as well as the proper release of information.
• Performs special focused projects/audits as assigned

QUALIFICATIONS:

Education: Associate’s Degree in Healthcare, Quality, Informatics, Computer Science, Business, or other Clinical related field preferred, or equivalent education, training, and/or experience.

Experience: Minimum 2 years’ experience within a healthcare setting

Licensure: NA