Government Programs Care Manager I
Health Care Service Corporation
Quality Manager – STARS, HEDIS
Arkos Health
full-time
Posted on:
Location Type: Hybrid
Location: Roswell • 🇺🇸 United States
Visit company websiteSalary
💰 $80,000 per year
Job Level
Mid-LevelSenior
About the role
- Providing oversight and direction to the STARS/HEDIS department
- Holding staff accountable to Departmental goals
- Scheduling and following 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)
- Managing staff in the STARS/HEDIS Department and assisting staff in quality initiatives, including STAR initiatives
- Collecting, reporting, and responding to metrics and contributing to the organization's drive to improve the overall experience of patient care
- Reviewing and providing performance feedback to the STARS/HEDIS department
- Establishing annual and monthly departmental and individual staff goals
- Ensuring the training and on-boarding of new staff
- Performing quarterly performance reviews of all Arkos Health STARS/HEDIS staff
- Providing education regarding STARS/HEDIS initiatives to staff and outside individuals
- Attending Arkos Health educational and demonstration activities, as needed and directed by Executive Medical Director.
- Performing the duties of STARS/HEDIS team members, as needed
- Reviewing data collected and developing strategies to improve performance
- Implementing strategies to improve department performance
- Creating, maintaining, and improving written department process flows and procedures
- Ensuring gaps in care are captured
- Coordinating and ordering preventative and diagnostic tests around gaps in care
- Conducting data entry and maintaining appropriate documentation and tracking for quality initiatives
- Educating patients on procedures that are being performed
- Participating in member chart review by conducting data extraction/collection using Insurance/Medicare guidelines
- Collaborating with the PCP in the management and care coordination for members with open gaps of care
- Demonstrating the ability to work collaboratively as a high performing quality team member
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.
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 codesHCC'sMedical DiagnosisABIDREUrine DipsMedical terminology
Soft skills
leadershipmanagementcommunicationcollaborationaccountabilityperformance feedbackgoal settingeducationtrainingprofessionalism
Certifications
Medical Assistant DiplomaCertified Nurse Assistant Certificationliability insurance coverage