Healthcare Quality Operations Coordinator

About the role

The Regional Quality Coordinator is responsible for managing quality operational support initiatives and overseeing special projects focused on improving healthcare performance measures such as HEDIS and CMS Star Ratings.

Responsibilities

• Supporting quality management efforts through data collection, medical record review, and claims surveillance.
• Conducting telephonic outreach to patients, providers, and pharmacies to promote medication adherence and healthcare improvements.
• Engaging with internal and external stakeholders to enhance patient experience and healthcare outcomes.
• Leading projects like Quality Fairs and Diabetic Days to close care gaps.
• Providing reports on quality performance and acting as a point of contact for provider groups.
• Participating in quality initiatives, meetings, and strategic planning.
• Utilizing knowledge of CMS, HEDIS, NCQA, HIPAA, and healthcare data systems.

Qualifications

• High school diploma or GED; related field or experience preferred.
• At least 2 years of healthcare-related experience, with clinical, managed care, or health plan background strongly preferred.
• Experience with CPT II codes and healthcare quality standards is a plus.

Skills

• Proficiency in Microsoft Office, electronic health records, and data mining.
• Medical terminology knowledge required.

Schedule

Hybrid schedule with in-office presence three days per week; travel within the region and work from multiple provider offices.

Pay

$22-$26 per hour based on experience.