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, Roswell, United States

About the role

• Quality Manager overseeing STARS/HEDIS department at Arkos Health, managing quality initiatives and staff performance for effective patient care. Collaborating with healthcare providers to enhance service delivery.

Responsibilities

• 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!