Under the direction of the Senior VP of Operations, this position is responsible to support the Quality Management team with quality outreach for year-round HEDIS/P4P/CMS star activities with an emphasis on Medication Adherence and Part D Measures. They will also assist in data collection and medical record extraction. The QM Generalist will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.

1.1 Ability to communicate effectively, verbally and in writing with members, providers and health plan representatives.

1.2 Be familiar with all manuals (HEDIS, P4P, CMS) and have a firm understanding of all quality measures and their criteria.

1.3 Works with QM staff to complete all requirements relative to HEDIS data collection and submission.

1.4 Works with various members of the Quality Department and Clinical Operations in order to pursue compliance with HEDIS/P4P/CMS Star measures.

1.5 Work with the Clinical Quality Specialist to analyze pharmacy data from both q. Metrics and the health plan websites to Identify gaps in care for Part D adherence measures and outreach to Pharmacies and members to identify barriers to Compliance.

1.6 Outreach to BFMC/CCPN members to schedule preventive screenings for all providers who have signed standing orders, and ensure that results from these screenings are received and forwarded to the PCP.

1.7 Review of medical records and extraction of data to meet measurement compliance.

1.8 Ensure lab orders initiated by the Quality Department are signed off and forwarded to their PCP.

1.9 Working knowledge of the QM systems.

1.10 Assist the Quality team with offsite Mammogram and Quality Gap Closure Clinics, as well as in-home screenings.

1.11 Maintain a professional working relationship with BFMC/CCPN Providers and their staff and be a resource to them for QM related topics.

1.12 Maintain patient confidentiality and follow HIPAA guidelines at all times.

1.13 Attend all staff meetings and complete in services and monthly trainings as required.

1.14 Cultural and Linguistics Training required annually.

1.14 Other duties as assigned.

Requirements:
8.1 High School Diploma/ GED equivalent.

8.2 Medical office experience preferred.

8.3Working knowledge of HEDIS/P4P/CMS Star measures and requirements.

8.4 Clean DMV record- Current CA driver's license, and current vehicle insurance.

8.5 Good organizational and time management skills.

8.6 Ability to communicate in a courteous and polite manner.

8.7 Computer skills: Microsoft Office, Excel, EMR systems.

The pay range for this position at commencement of employment is expected to be reasonably between $24.27 and $28.55. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Compensation: Between $24.27 and $28.55

BAKERSFIELD FAMILY MEDICAL GROUP, INC.

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Quality Management Generalist 1