Arkos Health

Quality Manager – STARS, HEDIS

Arkos Health

full-time

Posted on:

Location Type: Hybrid

Location: Cumming • 🇺🇸 United States

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Salary

💰 $80,000 per year

Job Level

Mid-LevelSenior

About the role

  • Provide oversight and direction to the STARS/HEDIS department.
  • Hold staff accountable to departmental goals.
  • Schedule and follow up on clinical care needs for patients as it relates to Quality Data, including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS).
  • Manage staff in the STARS/HEDIS Department and assist staff in quality initiatives, including STAR initiatives.
  • Collect, report, and respond to metrics and contribute to the organization's drive to improve the overall experience of patient care.
  • Review and provide performance feedback to the STARS/HEDIS department.
  • Establish annual and monthly departmental and individual staff goals.
  • Ensure the training and onboarding of new staff.
  • Provide day-to-day management of staff.
  • Perform quarterly performance reviews all Arkos Health STARS/HEDIS staff.
  • Provide education regarding STARS/HEDIS initiatives to staff and outside individuals.
  • Attend Arkos Health educational and demonstration activities, as needed and directed by Executive Medical Director.
  • Perform the duties of STARS/HEDIS team members, as needed.
  • Review data collected and develop strategies to improve performance.
  • Implement strategies to improve department performance.
  • Create, maintain, and improve written department process flows and procedures to improve the functioning of the department.
  • Ensure gaps in care are captured.
  • Coordinate and order preventative and diagnostic tests around gaps in care on behalf of the primary care physician utilizing standing orders/protocols required by the health plan.
  • Conduct data entry and maintain appropriate documentation and tracking for quality initiatives.
  • Educate patients on procedures that are being performed and the reason for performing them.
  • Participate in member chart review by conducting data extraction/collection using Insurance/Medicare guidelines.
  • Collaborate with the PCP in the management and care coordination for members with open gaps of care.
  • Demonstrate the ability to work collaboratively, efficiently, and effectively as a high performing quality team member, including collaborating with stakeholders when applicable.
  • Coordinate and participate in internal and external meetings.
  • Contribute as an active participant in quality initiatives.
  • Follow Arkos Health procedures, practices, policies, and guidelines to ensure the safety, security, and well-being of patients.
  • Perform other duties as assigned to support the overall effectiveness of the organization.

Requirements

  • Medical Assistant Diploma and/or Certified Nurse Assistant Certification
  • 1+ years’ experience as a manager.
  • 2+ years' experience in a healthcare environment
  • Recent and related experience working with HEDIS STARS Program
  • Experience in Electronic Health Records
  • Experience with verifying eligibility and navigating through Insurance Portals
  • Experience with CPT II codes
  • Basic knowledge HCC’s and Medical Diagnosis
  • Ability to perform multiply procedures with training (i.e.) ABI, DRE, Urine Dips
  • Familiarity of Medicare guidelines to perform patient screening’s
  • Knowledge of medical terminology
  • Current unrestricted state driver’s license with personal reliable transportation
  • Proof of liability insurance coverage
  • excellent leadership, management, and communication skills with ability to work collaboratively with other departments and external stakeholders; must be fluent in both spoken and written English and maintain professionalism in all verbal and written correspondence with both internal and external clients.
  • strong ability to self-manage time to manage multiple projects and priorities in a fast-paced environment
  • able to utilize necessary programs to ensure effective communication, collection of metrics, and proprietary software; including but not limited to: Microsoft product suite, Adobe Suite
  • strong analytical and problem-solving skills
Benefits
  • Employer-paid Medical premiums at no cost to you
  • Employer-paid Dental premiums at no cost to you
  • Employer-paid Vision premiums at no cost to you
  • Employer-paid Short-Term Disability premiums at no cost to you
  • Employer-paid Life Insurance premiums at no cost to you
  • Employer matching 401(k)
  • 15 days annual combined sick/vacation during your first year
  • 10 paid holidays
  • Your Birthday off!

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
HEDISSTARS ProgramElectronic Health RecordsCPT II codesHCCsMedical DiagnosisABIDREUrine DipsMedical Terminology
Soft skills
leadershipmanagementcommunicationcollaborationtime managementanalytical skillsproblem-solvingprofessionalismself-managementability to work in a fast-paced environment
Certifications
Medical Assistant DiplomaCertified Nurse Assistant Certification