- Manage activities to drive performance across several key quality metrics.
- Provide clinical expertise for all HEDIS related projects and interventions initiated by the Quality Team.
- Collaborate with Tandigm Care Team to provide outreach and support to patients with difficulty adhering to their medications, including ways to address patient barriers to adherence.
- Develop content and resources related to diabetes education to be shared with Tandigm Care Team.
- Contribute to the development of effective patient and provider-facing education and communication materials.
- When appropriate, travel to patients’ homes to provide screenings such as bone density scans or retinal eye screening.
- Manage performance related to rheumatoid arthritis measure though outreach to PCP and specialist offices as well as patient education.
- Support awareness month campaigns, including by organizing call campaigns for patients in need of screenings.
- Work with provider offices to obtain medical records and reports based missing quality metrics, perform clinical and non-clinical chart reviews, ensure data entered into quality tool.
- Monitor accuracy of abstracted records as required by HEDIS specifications
- Participate in in ongoing discussions concerning data collection, methodology, and data analysis for HEDIS and Star Measure projects.
- Understand HEDIS and Stars measures based on NCQA and CMS standards.
- Educate practices as needed on documentation requirements for certain HEDIS measures.
- Working with Accurate Coding and Education team, ensure that appropriate diagnoses indicative of compliance or exclusions are captured.
- Assist in preparing and implementing training for Clinical and Non-Clinical staff regarding HEDIS & Stars.
- Appropriately engage the Compliance Department to ensure that programs maintain Tandigm’s compliance with federal, state, and/or local regulators and laws, and are within Tandigm’s contracted obligations to all stakeholders.
- Consistently exhibit behavior and communication skills that demonstrate Tandigm’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
- Use, protect, and disclose Tandigm’s patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Communicate internally and externally as needed to gather necessary data.
- Attend to provider calls in accordance with exceptional customer service.
- Promote a positive working relationships.
- Perform duties in professional manner, utilizing time and resources efficiently.
- Perform other duties, projects and actions as assigned.
BSN required; MSN preferred; with
- Valid U.S. State Driver’s License as well as proof of liability and property damage insurance on any vehicle used for business purposes.
- Current PA Nursing License (RN) in good standing
- 5 years in quality improvement or clinical care aimed at improving patient outcomes.
- Experience with diabetes education/management preferred.
- Familiarity with electronic medical record systems preferred.
- Experience with managing programs preferred.
- Working knowledge of MS Office Suite (Excel, Word, PowerPoint); proficiency preferred
Essential Knowledge, Skills and Abilities
- Must embrace and exemplify the core vision and values of Tandigm Health.
- Working knowledge of the NCQA and CMS quality measures.
- Creativity and can-do attitude required to launch new initiatives.
- Ability to work independently on projects.
- Customer-service oriented; responsive and respectful to colleagues, clients, patients, and providers.
- Strong communication skills to work with both patients and provider offices.
- Ability and availability to travel independently to sites within the five county Philadelphia region, on a flexible schedule, as required.
- Proficient in MS Office Suite (Excel, Word, PowerPoint, Access).
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