Healthcare HEDIS/Quality Operations Coordinator

About the role

The Regional Quality Coordinator manages Quality operational support initiatives and oversees special projects, focusing on supporting HEDIS and Pharmacy gap closures. This position involves daily problem-solving, meticulous tracking, and coordination across departments to meet varying and changing requirements. The RQC oversees assigned affiliate groups, providing Quality operational support to clinics to achieve their goals, including engaging with internal and external stakeholders through in-person and telephonic outreach to patients for education and engagement on preventative screenings, data mining, medication adherence, and follow-up with primary care providers. This role may also involve direct patient interaction to complete tasks for quality gap closure. The Regional Quality Coordinator supports the assigned market under the direction of the market VP with assistance from the National Quality Manager.

Responsibilities

• Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA.
• Provide support to the Quality Management Department by working with members and network providers to improve quality of care through quality activities such as HEDIS, CMS Star Rating, and other quality performance reporting.
• Conduct telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other improvements related to healthcare performance measures.
• Improve patient experience and transitions for better healthcare outcomes through quality care.
• Participate in data collection through medical record and claims surveillance.
• Maximize health plan and healthcare provider performance on healthcare-related quality measures through effective telehealth communication with patients and coordination with caregivers, providers, and pharmacies.
• Assist in planning, implementing, and executing projects to improve quality and delivery of care services.
• Identify potential interventions to improve quality strategies using research and knowledge.
• Participate in Quality Management meetings and other initiatives.
• Prepare quality information for presentation to affiliate groups, including current standings relative to others and opportunities for improvement.
• Serve as the Point of Contact for provider groups designated by leadership.
• Lead project management of Quality Fairs, Diabetic Days, and P3 events to maximize quality gap closure.
• Act as a Subject Matter Expert in P3 machines (e.g., diabetic eye camera, bone density machine).
• Respond to health plan, provider, and interdepartmental calls in accordance with exceptional customer service standards.
• Review provider group gap uploads through the P3 Provider portal.
• Perform other duties as assigned.

Requirements

• High school diploma/GED required; associate degree in a related field or equivalent experience preferred.
• 2+ years of experience in healthcare-related fields required; clinical healthcare, managed care, or health plan experience strongly preferred.
• Experience with Microsoft Word, Excel, PowerPoint, Outlook, and general office equipment such as copiers and fax machines.
• Experience with Electronic Health Records (EHR) required.
• Medical Assistant Certification or experience as a Pharmacy Tech, Radiology Tech, Lab Tech, or similar strongly preferred.
• Experience with data mining preferred.
• Knowledge of medical terminology required; experience with CPT II codes preferred.
• Availability to travel within the assigned region and work from multiple provider offices as needed.
• Valid driver’s license, safe driving record, and reliable transportation required.

Schedule

This role offers a hybrid work arrangement, working in-office three days per week.

Pay

Pay range: $22 - $28 per hour, based on experience.

About P3 Health Partners

At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives, and engage patients. We are a physician-led organization relentless in our mission to positively disrupt the business of healthcare, transforming it from sickness care into wellness guidance. We are looking for individuals who are passionate about their work, eager to have fun, and motivated to be part of a fast-growing organization.