About Us:

We are a well-established boutique Independent Physician Association serving Los Angeles and San Bernardino Counties, contracting directly with Health Plans to provide both inpatient and outpatient care through our network of contracted physicians. 

Position Overview:

We are seeking a highly qualified, bilingual (English and Spanish) professional to support our Healthcare Effectiveness Data and Information Set (HEDIS)/STAR Ratings department. This role also includes fulfilling select CMS quality metrics that require documentation by a licensed registered nurse.    

Compensation & Benefits:

·        Hourly rate of pay is $30-40 dependent on experience / Full-time (40 hours per week)

·        Bonus:  Annual bonus potential based on established criteria

·        13 paid holidays

·        5 days paid sick leave after 90 days

·        5 days paid vacation

·        401K Plan after one full year of employment

·        Health Benefits stipend after 4 months of employment 

Essential Position Duties and Responsibilities:

●       Review daily, weekly, monthly, and yearly reports to identify target membership for care gap closures for Part C and Part D measures

●       Conduct member outreach and education to close care gaps

●       Work with health plans and designated personnel to assist in care gap closures

●       Assist in remote and/or onsite in MD office education for physicians & office staff regarding Annual Wellness Exams, monitor progress, and encourage physicians and patients to complete these exams in their entirety

●       Request and review electronic and faxed medical records

●       Collaborate on process development, implantation and monitoring to increase member compliance with HEDIS/STAR Measures

●       Utilize excellent communication skills to contact members via phone

●       Support and maintain an environment that promotes positive customer service, task completion, and optimal reporting

●       Assist physician offices in scheduling post-hospital discharge follow-up appointments

●       Reconcile medications and conduct telehealth reviews of post-DC needs

●       Attend health plan JOMs and other quality meetings and complete other duties as assigned

Required Qualifications:

●       Bilingual in English and Spanish

●       Valid California Registered Nurse license – verification is required

●       Minimum of 2 years of experience in healthcare or a managed care setting

●       Knowledge of HEDIS, STARS/Quality Measures and RAF/AV Programs for all lines of business

●       Excellent written and oral communication skills.

●       Ability to work independently as well as collaboratively on group projects.

●       Ability to find, gather, and collect information or data from databases and reports

●       Proficiency in Microsoft Office applications, including Word and Excel

Work Location:

●       In-office in Newport Beach, California