Provider Quality Liaison
Core
Connects with plan providers to share quality performance reports (HEDIS, CAHPS, HOS, Part D) and collaborates on mitigating low-performing measures and implementing quality best practices.
Role type
Provider Quality Liaison
Builds
Quality performance improvements for Medicare, Medicaid, and Ambetter plan providers
Domain
Healthcare administration / Quality improvement
Deliverable
dashboards & analysis
Required skills
HEDIS measures knowledge, provider engagement, quality improvement initiatives, P4P (Pay for Performance), CAHPS, HOS, CTMs, Disenrollments, Appeals, Grievances
Preferred skills
Pharmacy Technician, Medical Assistant, LVN, LPN, Social Work licensure
Technologies
HEDIS, CAHPS, HOS, P4P, RxEffect, CTMs
Responsibilities
Educate provider practices on HEDIS measures and medical record documentation guidelines; Act as an ongoing resource for quality improvement via regular meetings; Resolve provider practice site issues around quality metrics and grievances; Collaborate cross-functionally to build action plans for quality performance; Conduct telephonic outreach to members to close quality care gaps.
Seniority
Individual Contributor, 2+ years experience
