Hybrid Quality Manager – STARS, HEDIS

at Arkos Health

• Job title: Quality Manager – STARS, HEDIS
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $80,000 per year
• Degree requirement: Professional Certificate
• Location requirements: Hybrid, Cumming, United States

About the role

• Quality Manager overseeing STARS/HEDIS department for Arkos Health, a value-based healthcare company. Responsible for staff management, quality initiatives, and performance improvement.

Responsibilities

• 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!