Quality Manager - STARS/HEDIS

Job Description

Job Description

Salary: Starting at $80,000/ yr

Our Organization:

Welcome to Arkos Health! We are a value-based healthcare company providing solutions for payors and providers by combining unique technology with in-home, virtual, and in-clinical care for patients. Backed by a robust technology platform, innovative software, and a light human touch, Arkos Health is committed to delivering advanced and accessible community-based services allowing our clients to live healthier, more independent lives. How do we do this? Arkos serves health plans and provider organizations by managing their highest-risk and highest-cost populations. Our goal is to be the most valued partner to health plans, service providers, and the community we collectively serve.

How You'll Make a Difference:

Arkos Health is seeking a Quality Manager. The Quality Manager will be responsible for providing oversight and direction to the STARS/HEDIS department. The Quality Manager is tasked with holding staff accountable to Departmental goals. They will 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). The Quality Manager will manage staff in the STARS/HEDIS Department and assist staff in quality initiatives, including STAR initiatives. They will collect, report, and respond to metrics and contribute to the organization's drive to improve the overall experience of patient care, including the quality of health, and work to reduce the cost of care across the population served.

Essential Duties and Responsibilities:

• Review and provide performance feedback to the STARS/HEDIS department
• Establish annual and monthly departmental and individual staff goals
• Ensure the training and on-boarding 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. H. Perform the duties of STARS/HEDIS team members, as needed
• Review data collected and to 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.
• Educating 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

Qualifications and Skills:

• 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 HCCs and Medical Diagnosis
• Ability to perform multiply procedures with training (i.e.) ABI, DRE, Urine Dips
• Familiarity of Medicare guidelines to perform patient screenings
• Knowledge of medical terminology
• Current unrestricted state drivers license with personal reliable transportation
• Proof of liability insurance coverage
• Language & Communication Skills: 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.
• Decision Making: strong ability to self-manage time to manage multiple projects and priorities in a fast-paced environment
• Computer Skills: 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
• Problem Solving: strong analytical and problem-solving skills

Benefits:

• Employer-paidMedical premiumsat no cost to you
• 
  Employer-paidDental premiumsat 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 Insurancepremiums 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!

Must complete ourCulture Index Survey.Take the assessment at is not a pass/fail test and does not measure intelligence.

Arkos Health EEO Statement:

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

Arkos Healthis a drug-free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.

Arkos Health participates in E-Verify to confirm eligibility to work in the United States. To view the details on this program, visit our career page at Careers - Arkos Health