Clinical Quality Coordinator

Erickson Living is hiring a Clinical Quality Coordinator for our corporate office, located in Catonsville, MD. The Clinical Quality Coordinator will support and manage the auditing and appeals functions for the Erickson Advantage health care plan offered to our residents.
How you will make an impact:
Manages the monitoring, auditing and reporting requirements related to monthly, quarterly and annual regulatory and compliance requirements.
Manages Special Needs Plan regulatory requirements related to health risk assessments, model of care training, and nurse monitoring requirements etc.
Supports the Director of Quality and Care Management for the Annual Audit for delegated functions of health plan.
Project coordinates the 5 Stars Program deliverables and HRA process.
Responsible for managing the HRA process for all health plan member groups for achieving the Medicare 5 Star ratings.
Responsible for tracking progress of key deliverables for all components of the HRA outreach process and coordinating efforts with field based staff to achieve HRA resident confidentiality and abides by resident rights and responsibilities.
Assists with preparation for field chart reviews as related to Five Star measures and Delegation audit.
Manages the appeal process related to timeliness and documentation requirements per regulatory and health plan requirements. Some rotating weekend coverage required for responding to appeals request.
Assists with quality audits, preparing documentation, reports, obtaining data, and supporting onsite audit initiatives.
What you will need:
Knowledge of medical terminology for reviewing clinical documentation and health care quality measures (e.g. HEDIS and Five stars measures).
Knowledge of health care and insurance industries and health care delivery systems
Computer skills in Excel, WORD, Outlook and ability to use a variety of software applications to maintain records, analyze alternatives, evaluate trends, and to assist in problem-solving and decision-making responsibilities
Bachelor?s Degree in healthcare services or Associates Degree in healthcare quality management or a related field required. In lieu of degree, a minimum of five years of experience in health care quality measures, medical chart review, clinical quality auditing, working as an MDS coordinator, or in a clinical setting is required.
Computer skills related to database management and use of electronic medical record systems preferred.
Experience-in Special needs plan or auditing role for healthcare companies is strongly preferred.
Job: EA Clinical Quality Coordinator
Organization: Erickson Health Medical
Title: Clinical Quality Coordinator
Location: Maryland-Catonsville
Requisition ID: 18113600

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