Position: Quality & Risk Clinical Coordinator Nurse
Location: Fall River, MA
Job Type: Full - Time
Under the direction of the Chief Medical Officer, the Quality & Risk Clinical Coordinator (“Clinical Coordinator”) plays an essential role in managing the successful acquisition and reporting of quality metric data and risk coding to Steward Healthcare and other insurance companies.
The Clinical Coordinator will become familiar with national best practices for meeting quality metrics, and will assist offices with successful patient outreach for appointments and testing. The Clinical Coordinator will become familiar with the basics of ICD-10 risk coding and will participate in the workflow in each office in order to accurately code chronic conditions annually.
The Clinical Coordinator will communicate regularly with colleagues in Steward Healthcare, CareMax, Senior Whole Health, United Healthcare, and any other insurance companies where Prima CARE is “at risk” for quality and coding. The Clinical Coordinator will update Prima CARE on the requirements for meeting quality and coding targets and will update Prima CARE about any changes to these requirements.
The Clinical Coordinator will review the electronic medical record, eClinicalWorks (eCW) for clinical data, scheduled testing, exclusion criteria for specific quality measures, and for documentation that supports risk coding. The Clinical Coordinator will work closely with the Data Coordinator to organize quality data in a format suitable for reporting to each insurance company, and will help create rosters of patients who require annual visits, testing to meet quality metrics, or who have “gaps” in their risk coding.
Minimum Requirements and Skills:
Registered Nurse, with an active Massachusetts license.
- Interest, experience, and/or specific training in quality metrics, risk coding, or public health.
- Experience in a primary care office setting or in hospital nursing is desirable.
- Organized work habits and attention to detail. Ability to understand and analyze medical data,
medical documentation, and office and testing schedules.
- Ability to perform and understand audits of medical data and the results of data reports
presented by insurance companies.
- Ability to create accurate and organized reports of medical data and progress reports for
ongoing quality and coding projects.
- Ability to explain and instruct office staff about best practices for quality and coding, accurate
acquisition of medical data, and efficiency in office workflow.
- Ability to work calmly and effectively within time constraints to meet end-of-year targets for annual office visits, disease screenings, health maintenance targets (e.g., Blood pressure and diabetic control), and the coding of chronic medical conditions.
- Ability and willingness to help with patient outreach encouraging patients to comply with annual visits, necessary testing, and follow-up for medical conditions.
- Creativity and initiative to identify areas for improvement in current data gathering, management or workflows in the Quality and Coding Department or in the clinical offices.
- Understanding of and compliance with patient confidentiality laws (HIPAA).
- Ability to work with supervisory personnel, Information Technology experts, and the Chief
- Medical Office in achieving departmental and network goals.
- Ability to work as a team to accomplish organizational goals.
- Familiarity with Microsoft Word and Excel and eClinicalWorks.
Benefits for our Permanent Placements Include:
Medical, Dental, Vision and Life Insurance. 401K/ROTH and Safe Harbor Plans. Paid Time Off.
About PrimaCARE, P.C.:
Prima Care, P.C. was founded in 1996 and is a large, multi – specialty medical group serving southeastern New England. With over 150 providers, including primary care physicians and a broad range of specialists, we offer quality health care, a diversity of services and treatments, convenient and friendly service, and state –of-the-art testing facilities to support your diagnosis and treatments.
In addition to our main Fall River campus and walk-in Center, Prima Care has medical offices and Walk-In centers in Somerset, Westport, and Dartmouth, as well as satellite offices in Tiverton, Rhode Island. We also provide care in patient’s homes, nursing homes, and hospitals, and two Outpatient Physical Therapy clinics located in Fall River and Somerset, MA.
We live and work by the golden rule and our company values that include integrity, respect, professionalism, ethical behavior, and partnership.