Position Details

Department: Phx Children's Care Network
Category: PCCN
Location: Phoenix
Posting #: 478440
Date Posted: 10/1/2019
Employee Type: Regular

Position Summary

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.

PCH Values

  • 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.

Position Duties

  1. 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.
  2. Quality Improvement
    • 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.
  3. Administrative Functions
    • 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.
  4. Performs miscellaneous job related duties as requested.

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Position Qualifications

Please review the following qualifications and specify whether you meet each of the requirements listed.
Do you meet this requirement?
1. Bachelors Degree in Healthcare or a related field or a combination of education and relevant experience. Required
2. High School diploma or equivalent. Required
Do you meet this requirement?
1. 2 years of practice management or coordination experience Required
2. Experience with clinically integrated networks or accountable care organizations Preferred
Do you meet this requirement?
Special Skills
1. Strong communication skills are necessary for this person to efficiently and effectively work with providers and payers. Must be outgoing, results oriented and have the ability to work as a team Required
2. Working knowledge of software, including Microsoft Office suite Required
3. Ability and willingness to travel within assigned areas of responsibility Required
4. Works independently with integrity Required
5. Understand the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards and HIPAA Required
6. Basic knowledge of payer contracts, coding, and products Required
Physical Requirements & Occupational Exposure/Risk Potential
1. Physical Requirement - Climbing Occasionally
2. Physical Requirement - Feeling (sensing textures and temperatures) Constantly
3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) Constantly
4. Physical Requirement - Hearing Constantly
5. Physical Requirement - Pushing/pulling Constantly
6. Physical Requirement - Reaching Constantly
7. Physical Requirement - Sitting Constantly
8. Physical Requirement - Standing Constantly
9. Physical Requirement - Stooping/crouching/kneeling/crawling Frequently
10. Physical Requirement - Talking Constantly
11. Physical Requirement - Tasting/smelling Frequently
12. Physical Requirement - Walking Constantly
13. Physical Requirement - Near Vision Constantly
14. Physical Requirement - Far Vision Constantly
15. Physical Requirement - Color Discrimination Constantly
16. Physical Requirement - Use of keyboard, mouse and/or computer equipment Constantly
17. Physical Requirement - Lift up to 35 pounds without assistance Constantly
18. Physical Requirement - Lift more than 35 pounds without assistance Constantly
19. Occupational Exposure/Risk Potential - Inside office environment Applicable
20. Occupational Exposure/Risk Potential - Outdoor weather conditions Applicable
21. Occupational Exposure/Risk Potential - Extreme temperatures Applicable
22. Occupational Exposure/Risk Potential - Airborne communicable diseases Applicable
I have reviewed the qualifications, physical requirements and occupational exposure/risk potential for this position and wish to apply