Quality Specialist II at True Health – Sanford, Florida

JOB SUMMARY:

The Quality Specialist II helps to ensure True Health provides the highest quality of services to their patients. This position addresses basic and complex support needs of the individual patient and assists in coordination of the therapeutic aspects of the services provided. This coordination will close care gaps for patients through education, assessing, monitoring, linking and advocation for individuals in conjunction with direct care providers. They function as a liaison between administration, staff, and patients to reach healthcare goals and keep the lines of communication open.

PRIMARY FUNCTIONS

1. Plan with the patient, family/caregiver, primary care provider, support staff, payers, and the community resources, to maximize healthcare responses, quality, and cost-effective outcomes.
2. Facilitate communication and coordination between members of the healthcare team, involve the patient in the decision-making process to minimize fragmentation in the services.
3. Educate the patient, family or caregiver, and members of the healthcare delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, care coordination, etc., so that timely and informed decisions can be made.
4. Empower the patient to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes.
5. Encourage the appropriate use of healthcare services and strive to improve quality of care and maintain cost effectiveness on a case-by-case basis.
6. Assist the patient in the safe transitioning of care to the next most appropriate level.
7. Strive to promote patient self-advocacy and self-determination.
8. Advocate for the patient to facilitate positive outcomes for the patient, health care team, and payers.
9. Attending monthly meetings with insurance payers to have a consistent line of communication open and assist with setting goals for quality improvement.
10. Work on projects as assigned based on priorities received from insurance companies.
11. Stay involved and active with quality improvement activities.
12. Conduct chart audits to determine quality compliance and documentation opportunities
13. Proficient in clinical knowledge to aid other non-clinical colleagues with closing care gaps as needed.
14. Other projects/duties as assigned

EDUCATION AND EXPERIENCE

1. Current Florida LPN License, active and in good standing, preferred
2. Certified Medical Assistant active and in good standing, considered

KNOWLEDGE, SKILLS, AND ABILITIES

1. One (1) year minimum experience in Clinical Care Coordination, Care Planning or Chronic Care Management.
2. Computer competency is required
3. One (1) year minimum experience with an EHR (Athena Health preferred)

ADDITIONAL QUALIFICATIONS

1. Bilingual is a plus (English/Spanish)
2. Must be a collaborator but able to work independently
3. Excellent spoken and written communications skills
4. Must have reliable transportation

RELATIONSHIP REPORTING

1. Reports to Quality Manager

PHYSICAL REQUIREMENTS

1. Ability to view a computer screen for extended periods of time
2. Ability to perform repetitive hand and wrist motions for extended periods of time
3. Ability to communicate effectively with patients and staff