Managed Care Assistant

POSITION SUMMARY: The Managed Care Assistant supports the Managed Care and Quality departments by coordinating medical record collection, performing HEDIS data abstraction, preparing charts for review, and assisting with quality improvement initiatives. This role is responsible for ensuring the accurate and timely retrieval, organization, and submission of medical record documentation to support HEDIS. This position will focus on closing quality care gaps in conjunction with working special projects as assigned by DMC. This position will involve staff and patient involvement implementing an organization-wide multilevel program using evidence-based interventions. This position will also support the Managed Care Team in various capacities including education, training, and supporting HEDIS and STARS campaigns.

MINIMAL QULAIFICATIONS:

• Certification/Registration - Medical Assistants must be certified or registered and certified and registered Medical Assistants must maintain certification, OR
• Florida Licensed Practical Nurse (LPN)
• Current CPR
• High school diploma
• Clinical Experience

EXPERIENCE: Required:

• Minimum of 2 years of experience as a Clinical Medical Assistant and/or License Practical Nurse
• Experience with Microsoft Word, Excel, and PowerPoint
• Experience with electronic health records

Preferred

• Knowledge of Managed Care guidelines
• Knowledge of HEDIS and STARS Measures
• Ability to work under tight deadlines and remain flexible
• Exceptional team, communication, and written/oral skills

RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:

• Provides positive customer experiences with internal (co-workers) and external (patients and collaborative partners) customers
• Maintains awareness of CFHC’s mission, vision, and overarching goal
• Maintains understanding and knowledge of, and remains compliant with CFHC’s policies and procedures, particularly those pertaining to role
• Assist in directing the required data abstractions and coordinate implementation of clinic processes including EMR queries to identify baselines and detect screening outcomes for the organization
• Develop and implement Managed Care Campaigns to support HEDIS and STARS screenings and measures. Pull care reports, monitor and update care gaps.
• Works with Managed Care payors and collaborate reports, managed care team to provide cross- functional support including patient outreach, communication.
• Complete other duties assigned by Director of Managed Care to support the Managed Care Team.

PHYSICAL REQUIREMENTS:

• Requires 80% or more time spent standing/walking.
• Independently mobile
• Ability to lift weights equivalent to what would be required when occasionally assisting and positioning patients, repositioning equipment and lifting supplies.
• Ability to adapt and function in varying environments of workload, patient acuity, worksites, and work shifts.

American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case-by-case basis.