P4Q Practice Coordinator - Clinical Quality Liaison
HealthSpring - Baltimore, MD

This job posting is no longer available on HealthSpring. Find similar jobs: Practice Coordinator jobs - HealthSpring jobs

Coordinates and manages relationships with single office practices to multiple provider practices in HealthSpring’s P4Q or P4Q 2 programs. Consistently monitors participating provider performance on the identified P4Q and/or HEDIS STAR measures and regularly communicates status of those measures to the appropriate HealthSpring team members. Establishes and maintains regularly scheduled contact with designated P4Q or P4Q 2 Program Point-of-Contact in each participating office and conducts on-site visits in those offices. Coordinates and ensures that all communication is maximized effectively between the practice, health plan, and any disease management vendors.

Required Skills Coordinate and manage relationships with participating provider practices: Initiate and maintain ongoing productive and positive relationships with designated Point-of-Contact in each practice. Facilitate resolution of any discrepancies between claims and practice medical records. Communicate pertinent care and/or clinical information to the health plan for follow-up or inclusion in Company’s medical records. Maintain physical presence in participating. Serve as ongoing resource and support for P4Q or P4Q 2 Program needs in identified practices. Assist with communication between Point-of-Contact and practice staff/physicians. Participate in all operational meetings/calls as identified between practices and the health plan. Participate in regularly scheduled Practice Coordinator team conference calls.

Partner with in-office Point-of-Contact(s) to ensure practice success: Review and participate in audits of medical records. Coordinate real-time performance measure management across multiple practices that provide care for members in total by utilizing the designated Company system. Ensure that participating practices are driving improvement on P4Q or P4Q 2 Program performance measures. Review data for those members that are frequent users of healthcare resources to ensure they are receiving the proper coding and care. Suggest physician referrals to case management or behavioral health. Communicate real-time updates to identified Company team members. Develop and maintain a process to ensure that all members in participating practices receive the screenings and services needed within the given timeframe. Maintain detailed understanding (including clinical, coding, and operational knowledge) of all P4Q or P4Q 2 Program (HEDIS STAR) performance measures. May assist with data collection related to proper coding and documentation .

Required Experience Minimum Requirements: Unrestricted Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) in the applicable state. At least one year related experience in a healthcare environment. Excellent written and oral communication skills; excellent problem solving skills; highly organized and proactive; ability to handle multiple tasks and set priorities; detailed oriented; works independently with minimum of supervision. Ability to travel to and work at participating practices.

Preferred Requirements: Current licensure as a Registered Nurse (RN), Nurse Practitioner, or Physician’s Assistant in applicable state. Minimum of two years clinical practice experience in a providers’ office or hospital setting. At least five years HEDIS related experience and/or solid working knowledge of HEDIS measures.

HealthSpring is an EEO/AA employer.

About this company
34 reviews
Looking to keep a spring in Grandma's step, HealthSpring provides Medicare Advantage plans and Medicare Part D prescription drug...