DaVita QI Coordinator- Patient Support Center in TORRANCE, California

QI Coordinator- Patient Support Center

Description

DaVitaMedical Group manages and operates medical groups and affiliated physiciannetworks in California, Nevada, New Mexico, Florida, Colorado and Washington inits pursuit to deliver excellent-quality health care in a dignified andcompassionate manner. As of September 30,2016 DaVita Medical Group (formerlyHealthCare Partners) provided integrated care management for approximately760,000 patients. DaVita Medical Group’s leadership development initiatives andsocial responsibility efforts have been recognized by Fortune, ModernHealthcare, Newsweek and WorldBlu.

We arecommitted to bringing the benefits of coordinated care to our patients and totaking a leading role in the transformation of the national healthcare deliverysystem to assure quality, access, and affordable care for all.

Ifyou're looking to make a difference with a large, financially stable,well-recognized medical group, DaVita Medical Group may be the employer foryou.

Overview:

Responsiblefor providing administrative support for one or more Quality Improvement (QI)Specialist in the form of coordinating the process for receipt ofgrievances/complaints from internal or external sources. Maintains providerdatabases as required, coordinates and communicates QI and Peer Review meetingschedules, and interfaces with other administrative departments.

Essential Functions:

  • Consistently exhibits behavior and communicationskills that demonstrate HealthCare Partners’ (HCP) commitment to superiorcustomer service, including quality, care and concern with each and everyinternal and external customer.

  • Initiates, triages and maintains all quality ofcare, concerns and grievance files according to QI Specialist policies andprocedures.

  • Conducts weekly review of all grievance files anddatabase logs and performs any necessary follow-up with internal customers andexternal agencies.

  • Inputs data and maintains the QI database andprovider PR files, logs grievance information, Peer review outcomes,credentialing/re-credentialing information and QI studies as applicable.

  • Produces reports based on database information fortracking, trending and quality of care issues by provider, site or concern.

  • Maintains grievance turnaround time complianceaccording to contractual requirements and reports weekly, monthly, quarterlyand as requested by the QI Specialist.

  • Coordinates the Quality Improvement, Peer Reviewand WPI meetings by preparing the meeting notification, agendas, copyingpackets, taking and preparing minutes in a timely manner, etc.

  • Initiates and maintains the QI credentialing andre-credentialing process and ensures that all appropriate documentation (sitereview, medical record reviews, study participation, and grievance outcomes) isforwarded to the Credentialing department in a timely manner.

  • Processes all expedited credentialing requestswithin 72 hours.

  • Coordinates office/administrative supportactivities and performs clerical tasks such as typing, phones, officemanagement, creating files and filing, ordering medical records, copying,mailing.

  • Assists with departmental projects and studies asrequested (e.g., HEDIS, access, wait time, etc.)

  • Acts as a liaison, contact person and/or frontlinerepresentative to external HMOs and other agencies and maintains a positive andprofessional relationship with all internal and external staffs and departments(health plans, area hospitals and providers).

  • Maintains confidentiality of all grievance issues,reports and all information related to Quality Improvement.

  • Uses, protects, and discloses HCP patients’protected health information (PHI) only in accordance with Health InsurancePortability and Accountability Act (HIPAA) standards.

  • Performs additional duties as assigned.

Qualifications

EDUCATION:

  • High school diploma, G.E.D. or equivalent. Includes special certification required forspecific jobs.

EXPERIENCE:

Minimum:

  • Over 1 year and up to and including 3 years of experience.

  • Experience with data entry, word processing and useof menu-driven computer applications.

Preferred:

  • 1 to 2 years experience in a healthcare setting orrelated field.

KNOWLEDGE, SKILLS, ABILITIES:

  • Computer literate.

  • Working knowledge of database management.

  • Knowledge of medical terminology.

  • Good verbal and written communication skills.

  • Ability to effectively interact with all employees,providers, health plans and other customers at all organizational levels, bothinternal and external.

  • Ability to work effectively as part of a team andadapt to organizational change and work within an environment of continuousevolution and change.

  • Excellent organizational skills.

  • Detail-oriented.

  • Multi-tasking, time management and prioritizationskills.

  • Self-starter and highly motivated.

Primary Location CA-TORRANCE - 90503

Req ID: 306149