Are you passionate about healthcare and eager to contribute in a collaborative and inclusive environment? If you’re seeking a fresh start with a focus on work-life balance, consider joining our team as we work towards creating a healthier Upper Peninsula.
We offer a range of benefits designed to support your well-being and professional growth, including:
- No nights, weekends, or holidays
- Generous time off: Vacation, Sick, Volunteer, and Personal Time
- 12 Paid Holidays
- Life and Disability Insurance with no premium cost
- 401(k) with a safe harbor contribution
- Tuition Reimbursement
- Student Loan Repayment Assistance
- Fitness Center Reimbursement
- And much more!
POSTED: September 18, 2024
POSITION: Clinical Coordinator—PGIP
DEPARTMENT: Clinical Services
FLSA STATUS: Nonexempt
BASE RATE: $24.75 per hour, with potential for additional compensation based on qualifications.
POSITION SUMMARY:
Performs assigned duties and clinical functions in accordance with Upper Peninsula Health Plan (UPHP) plans, policies, and procedures, all state and federal accrediting and regulatory standards and Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information.
2. Performs all assigned tasks in accordance with UPHP plans, policies and procedures, as well as National Committee for Quality Assurance (NCQA), BCBSM PGIP, and all regulatory standards.
3. Assists in the development and maintenance of policies and procedures related to PGIP and other assigned programs in accordance with program, regulatory, and accrediting standards.
4. Prepares reports and educational materials as required and presents reports and educational information via webinars and forums.
5. Engages with practices to onboard and participate with BCBSM PGIP initiatives. Assists in the development of practice incentive design, as requested.
6. Conducts onsite assessments with participating practices at least annually to determine BCBSM PGIP initiative progress; this includes scheduling, travel arrangements, onsite assessment, and post assessment follow-up.
7. Demonstrates knowledge of all BCBSM PGIP requirements; Centers for Medicare and Medicaid Services (CMS) standards; all applicable NCQA standards; and Healthcare Effectiveness Data and Information Set (HEDIS) measures as they relate to clinical functions and respective programs; assumes responsibility for specific NCQA and BCBSM standards as assigned.
8. Participates in departmental and interdepartmental process improvements; recommends improvements in clinical processes as opportunities are identified.
9. Participates in internal and external workgroups, collaboratives, and specialized trainings as required by BCBSM and/or UPHP.
10. Serves as backup to other team members in their respective areas in demonstrated times of excessive workload and/or benefit time.
11. Attends and participates in BCBSM PGIP and UPHP organizational, departmental, and clinical program meetings as required.
12. Assures required licensure continuing education requirements are fulfilled on an annual basis.
13. Maintains confidentiality of client data.
14. Performs other related duties as assigned or requested.
POSITION QUALIFICATIONS:
Education:
Required:
Licensed practical nurse, associate degree in nursing, or degree in health care-related area; if nursing degree, licensed in state of Michigan. Three (3) years of clinical or health related experience will be considered in lieu of certification or degree
Experience:
Minimum:
One (1) year of clinical or health-related experience
Preferred:
Two (2) to three (3) years of clinical experience; understanding of clinical quality data and
performance improvement.
Other Requirements:
Valid driver’s license
Required Skills:
Keyboarding proficiency and working knowledge of MS Office programs (Word, Excel, and PowerPoint)
Excellent human relation and oral/written communication
Excellent organizational and prioritization abilities
Desired Skills:
Ability to interpret and analyze data
Working knowledge of MS Office Access, Canva, Monday.com, and Webinar platforms (i.e., Microsoft Teams)
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
Physical Requirements:
[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:
Ability to access departmental files
Ability to enter and access information from a computer
Ability to access all areas of the UPHP offices
Moderate physical effort (lift/carry up to 25 pounds)
Occasionally lifts supplies/equipment
Occasional reaching, stooping, bending, kneeling, crouching
Prolonged periods of sitting
Occasional prolonged standing
Manual dexterity and mobility
Working Conditions:
Position available onsite (in Marquette, Michigan), fully remote, or hybrid with a remote work option up to three (3) days per week
Works in office conditions, but frequent travel across the Upper Peninsula of Michigan and periodic conference travel and travel in the Lower Peninsula Michigan is required
Subject to many interruptions
Exposure to situations requiring exceptional interpersonal skills or high productivity
Frequently subjected to irregular hours
Remote Work Requirements:
Must reside in the Upper Peninsula of Michigan
For remote team members, initial on-site/in-person onboarding and training for a minimum of ten (10) consecutive business days at UPHP’s headquarters in Marquette, Michigan (stipend provided)
Periodic travel to UPHP’s headquarters for regular training including all staff meetings
Private home office required; computer and phone hardware provided
Personal vehicle and proof of insurance required for business travel; mileage reimbursement provided at GSA rate
