Job Description
The Quality Care Coordinator (QCC) assists the providers and leadership team in accomplishing the highest percentage of member compliance for the annual goals of HEDIS, IHA, and STAR measures, as well as Annual Wellness Visits. Using Cozeva and other quality platforms, the QCC will enter data from medical record review, document conversations held with members or healthcare providers, and review data on reports. The QCC reviews patient due reports from Cozeva (or similar platforms) and organizes the data in preparation for member outreach. Through a combination of mailing patient due letters or education flyers, calling the patient and/or healthcare provider, creating referrals, and conducting warm-handoffs; the QCC is the professional representative of striving for patient satisfaction. The QCC is also responsible for providing general education related to the quality measures showing “due”, as member outbound or inbound calls are conducted. **
Responsibilities**
Qualifications
Minimum Education: High School Diploma or General Education Development (GED) required. **
Minimum Experience: A minimum of three plus (3+) years of IPA/HMO experience and one plus (1+) year/s in P4P/HCC/CMS Star Programs experience. Ability to project excellent customer service, negotiation, and conflict resolution skills via telephone while maintaining a professional demeanor.
Req. Certification/Licensure: None.
About Us**
With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.
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