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Job Summary
The
Quality Specialist II
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
Seniority level Seniority level Entry level
Employment type Employment type Full-time
Job function Job function Health Care Provider
Industries Hospitals and Health Care, Medical Practices, and Non-profit Organizations
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