How You’ll Help

As a member of the UpStream quality team, you will help with driving clinical quality metric outcomes. You will be assisting members with chronic care conditions to receive the quality of care they deserve. You will be working with providers and internal teams on validation activities. The quality coordinator would review data and reach out to members and providers to help close care gaps.

What You’ll Do

1. Outreach to patients to close outstanding quality HEDIS® gaps. These activities may be deadline sensitive and productivity standards may apply.
2. UpStream internal platform will be used to close Quality care gaps.
3. Chart review activities as requested by either payor partners or UpStream leadership. Must meet productivity and accuracy standards as applicable. Require deep understanding of gap closure specifications. Training and resources will be provided.
4. Follow UpStream guidance on documentation process adhering to HIPAA requirements, guidance on documentation gathering including naming convention and security protocols.
5. Education of internal and external parties as requested by leadership.
6. Primary Source Verification Audits. Will compare EMR documentation with results reflected in the system.
7. Recommend process improvement both internally and within the practices. Help to identify and break down barriers for gap closure.
8. Other projects as assigned but not limited to quality measure specific projects, uploading data into payor systems as requested, subject matter experts to internal process improvement projects and data validation projects.
9. Coordinate, complete and update on all quality process and results.

Experience and Skills You'll Need

• High School diploma required
• Experience with HEDIS® quality metrics preferred
• Proficient in using Microsoft 365, Word, and Excel
• Knowledge of medical terminology, standard medical practices, and quality improvement process
• Excellent written and verbal communication skills
• Excellent customer service skills
• Ability to maintain a positive attitude and connect with patients and physicians
• Must be able to work independently and interdependently within a team
• Strong analytical, critical thinking skills and attention to detail
• Must be self-motivated and willing to adapt to changing processes
• Electronic Medical Records (EMR) software and working in quality platforms experience preferred
• Experience with outbound calls to patients preferred.
• Previous experience in primary care or other clinically related field preferred
• Bachelor’s degree in related field or equivalent experience preferred
• A desire to be part of something bigger than oneself