Healthcare HEDIS/Quality Operations Coordinator - Medford

About the role

The Regional Quality Coordinator role manages Quality operational support initiatives and oversees special projects, focusing on HEDIS and Pharmacy gap closures. The position requires daily problem‑solving, meticulous tracking, and cross‑departmental coordination to meet changing requirements. The RQC oversees assigned affiliate groups, providing Quality operational support to clinics to achieve goals through in‑person and telephonic outreach to patients for education on preventative screenings, data mining, medication adherence, and follow‑up with primary care providers. This role may involve direct patient interaction to close quality gaps and supports the assigned market under the market VP with assistance from the National Quality Manager. At P3 Health Partners, our mission is to guide communities to better health, unburden clinicians, align incentives, and engage patients by transforming sickness care into wellness guidance.

Responsibilities

• Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA
• Provides support to the Quality Management Department by working with members and network providers to improve quality of care through activities such as HEDIS, CMS Star Rating, and other quality performance reporting
• Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or improving healthcare performance measures
• Improves patient experience and transitions for better healthcare outcomes through quality care
• Participates in data collecting through medical record and claims surveillance
• Works to maximize health plan and healthcare provider performance on healthcare‑related quality measures through effective telehealth communication with patients and coordination with patient caregivers, providers, and pharmacies
• Assists in planning, implementing, and executing projects to improve quality and delivery of care services
• Uses research and knowledge to identify potential interventions to improve quality strategies
• Participates in Quality Management meetings and other initiatives
• Prepares quality information for presentation to affiliate groups, including current standings relative to others and opportunities for improvement
• Serves as Point of Contact for provider groups designated by leadership
• Leads project management of Quality Fairs, Diabetic Days, and P3 events to maximize quality gap closure
• Acts as Subject Matter Expert in P3 machines (diabetic eye camera, bone density machine, etc.)
• Responds to health plan, provider, and interdepartmental calls with exceptional customer service
• Reviews provider group gap uploads through the P3 Provider portal
• Travels within the assigned region as needed; must have a valid driver’s license, safe driving record, and reliable transportation
• Performs other duties as assigned

Qualifications

• High school diploma/GED required; associate degree in related field or equivalent experience preferred
• 2+ years experience in healthcare‑related fields required; clinical health care, managed care, or health plan experience strongly preferred
• Experience with Microsoft Word, Excel, Power Point, Outlook and general office equipment (copier, fax machine) required
• Experience in Electronic Health Records required
• Medical Assistant Certification or experience as a Pharmacy Tech, Radiology Tech, Lab Tech, or similar strongly preferred