Partnership HealthPlan of California
Clinical Compliance Coordinator I
Partnership HealthPlan of California, Redding, California, United States, 96001
Overview
To provide coordination and implementation of support of the defined tasks for the DHCSmandated Site Review process and other assigned projects. The Clinical Compliance CoordinatorI will assist the Clinical Compliance Inspector RN's and Inspections Team in obtaining andcompleting the Site Review process according to PHC department guidelines. This position willassist in ensuring adequate and timely audit documentation and will perform provider educationand establish rapport with the provider network to help improve member health status and healthcare quality along with a positive provider experience.
Responsibilities
Collects data and documentation in support of clinical site reviews of provider locations,including physicians, non-accredited facilities, and other provider types, usingestablished criteria and guidelines to evaluate the facility and medical records.Tracks and follows up on Corrective Action Plans (CAPs) and other information to besubmitted to PHC, to ensure evidence of corrective actions are in place.Provides support and resources to providers to assist in completing required correctiveactions.Ensures all review documentation is completed, organized and entered into the programdata system per established timelines.Participates in training, staff meetings and/or offsite meetings as needed to assureprogram deliverables and timelines are met.Participates in regulatory audits as needed.Assists with workgroups/special projects for department as assigned.Provides guidance and assistance to Provider network and/or support employees.Reports any instances of noncompliance, such as access issues or quality concerns tomanagement and/or the appropriate department.Maintains specialized certification as appropriateDevelops expertise in program focus areas and stays informed of key developments andtraining/development opportunities within our network and across the healthcareindustry.Establishes and maintains effective interpersonal relationships with all levels of staff,agencies, and providers.Other duties as assignedQualifications
Education and Experience
High School diploma or equivalent. Minimum of one (1) year of workexperience in a healthcare setting with a basic understanding ofmedical terminology is required. General knowledge of managed carewith an emphasis in Quality preferred.
Special Skills, Licenses and
Certifications
Familiarity with business practices and protocols with the ability toaccess data and information using automated systems. Ability to workwithin an interdisciplinary structure and function independently in afast-paced environment while managing multiple priorities and meetingdeadlines. Strong organizational skills required. Effective telephoneand computer data entry skills are required. Valid California driver'slicense and proof of current automobile insurance compliant with PHCpolicy are required to operate a vehicle and travel for companybusiness.
Performance Based Competencies
Excellent written and verbal communication skills. Ability tounderstand and follow established criteria and protocols used inmanaged care functions. Ability to formulate ideas and solutions intoappropriate questions and assess/interpret the verbal responses. Abilityto apply clinical judgment and make quick decisions. Ability tocommunicate effectively with coworkers, physicians, and health careproviders.
Work Environment And Physical Demands
Daily use of telephone and computer for most of the day. Potential forsome travel. Cubicle workstation. Ability to use a computer keyboard.Must be able to lift, move, or carry objects of varying size, weighing upto 10 lbs.
All HealthPlan employees are expected to:
Provide the highest possible level of service to clients;Promote teamwork and cooperative effort among employees;Maintain safe practices; andAbide by the HealthPlan's policies and procedures as they may from time to time be updated.
HIRING RANGE:
$34.79 - $43.48
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
To provide coordination and implementation of support of the defined tasks for the DHCSmandated Site Review process and other assigned projects. The Clinical Compliance CoordinatorI will assist the Clinical Compliance Inspector RN's and Inspections Team in obtaining andcompleting the Site Review process according to PHC department guidelines. This position willassist in ensuring adequate and timely audit documentation and will perform provider educationand establish rapport with the provider network to help improve member health status and healthcare quality along with a positive provider experience.
Responsibilities
Collects data and documentation in support of clinical site reviews of provider locations,including physicians, non-accredited facilities, and other provider types, usingestablished criteria and guidelines to evaluate the facility and medical records.Tracks and follows up on Corrective Action Plans (CAPs) and other information to besubmitted to PHC, to ensure evidence of corrective actions are in place.Provides support and resources to providers to assist in completing required correctiveactions.Ensures all review documentation is completed, organized and entered into the programdata system per established timelines.Participates in training, staff meetings and/or offsite meetings as needed to assureprogram deliverables and timelines are met.Participates in regulatory audits as needed.Assists with workgroups/special projects for department as assigned.Provides guidance and assistance to Provider network and/or support employees.Reports any instances of noncompliance, such as access issues or quality concerns tomanagement and/or the appropriate department.Maintains specialized certification as appropriateDevelops expertise in program focus areas and stays informed of key developments andtraining/development opportunities within our network and across the healthcareindustry.Establishes and maintains effective interpersonal relationships with all levels of staff,agencies, and providers.Other duties as assignedQualifications
Education and Experience
High School diploma or equivalent. Minimum of one (1) year of workexperience in a healthcare setting with a basic understanding ofmedical terminology is required. General knowledge of managed carewith an emphasis in Quality preferred.
Special Skills, Licenses and
Certifications
Familiarity with business practices and protocols with the ability toaccess data and information using automated systems. Ability to workwithin an interdisciplinary structure and function independently in afast-paced environment while managing multiple priorities and meetingdeadlines. Strong organizational skills required. Effective telephoneand computer data entry skills are required. Valid California driver'slicense and proof of current automobile insurance compliant with PHCpolicy are required to operate a vehicle and travel for companybusiness.
Performance Based Competencies
Excellent written and verbal communication skills. Ability tounderstand and follow established criteria and protocols used inmanaged care functions. Ability to formulate ideas and solutions intoappropriate questions and assess/interpret the verbal responses. Abilityto apply clinical judgment and make quick decisions. Ability tocommunicate effectively with coworkers, physicians, and health careproviders.
Work Environment And Physical Demands
Daily use of telephone and computer for most of the day. Potential forsome travel. Cubicle workstation. Ability to use a computer keyboard.Must be able to lift, move, or carry objects of varying size, weighing upto 10 lbs.
All HealthPlan employees are expected to:
Provide the highest possible level of service to clients;Promote teamwork and cooperative effort among employees;Maintain safe practices; andAbide by the HealthPlan's policies and procedures as they may from time to time be updated.
HIRING RANGE:
$34.79 - $43.48
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.