Posting Note: This position will require travel throughout Maricopa County visiting primary care offices approxixmately 60% of the time. You will engage and effectively work with our providers to improve the quality experience for our patients by evaluating and improving quality measures. You must have a fundamental understanding of billing, HEDIS measures and quality assurance. This role will require someone who is self-directed, enjoys influencing and guiding other professionals as you drive quality improvements. If you have previous experience working in pediatrics, or you have been a hospital representative, please apply!
This position is responsible for developing and maintaining cooperative working relationships with providers in the Phoenix Children’s enterprise, Phoenix Children’s Medical Group (PCMG) and the Phoenix Children’s Care Network (PCCN). In addition, this position is responsible for ensuring that all, contractual, financial and clinical integration requirements are adhered to and achieved through provider education, provider training, collaborative problem solving and trend identification.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Provider Network Operations
- Researches and resolves incoming escalated provider inquiries within contract guidelines; educates providers on new protocols, quality metrics, clinically integrated organizational protocols, organizational policies, and procedures.
- Schedules and attends visits with identified PCCN providers, nurses, referral coordinators, practice managers and other office staff at clinics in assigned territory to establish relationships.
- Performs periodic audits of network practices to ensure adherence to network protocols and adopted clinical guidelines.
- Assists with the development and implementation of provider training programs, including but not limited to HEDIS and quality metric performance. Serves as the main PCCN provider training resource.
- With support of data from the analytics team, monitors and analyzes Quality Improvement (QI) outcomes to ensure network goals, objectives, outcomes, accreditation and regulatory requirements are met.
- Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail based on functional knowledge.
- Acts as an agent of change in the network and communicates the vision for change by sharing best practices and clinical pathways to support improved patient care, satisfaction and appropriate utilization of healthcare resources.
- Works independently to schedule time with practices and adheres to the schedule or updates as necessary in a transparent fashion to justify time out of office.
- Documents encounters with each practice within one business day to maintain up-to-date, accurate, and complete visit details.
- Performs miscellaneous job related duties as requested.