Job Overview
We are seeking a dynamic and detail-oriented Clinical Quality & Outcomes Coordinator to join our healthcare team. In this vital role, you will drive excellence in clinical documentation, quality improvement initiatives, and outcomes analysis across various care settings. Your expertise will support compliance with healthcare regulations, optimize patient care processes, and enhance overall clinical performance. This position offers an exciting opportunity to influence patient outcomes positively while working within a collaborative, fast-paced environment dedicated to healthcare excellence.
Duties
- Lead clinical documentation improvement efforts by reviewing medical records for completeness, accuracy, and adherence to documentation standards aligned with Medicaid.
- Collaborate with interdisciplinary teams to ensure accurate coding using CPT (Current Procedural Terminology), ICD-9, ICD-10, DRG (Diagnosis-Related Group), and ICD coding systems to support proper reimbursement and data integrity.
- Conduct utilization management activities by reviewing inpatient and outpatient cases, ensuring appropriate level of care, discharge planning, and compliance with Medicare regulations and long-term care standards.
- Analyze clinical outcomes data to identify trends, gaps in care, and opportunities for quality improvement initiatives across acute care, long-term care, home care, hospice, and outpatient settings.
- Maintain up-to-date knowledge of healthcare policies including HIPAA (Health Insurance Portability and Accountability Act), state healthcare regulations, NCQA (National Committee for Quality Assurance) standards, and CMS policies to ensure ongoing compliance.
- Utilize EMR/EHR systems such as Epic, Cerner, Athenahealth, eClinicalWorks, or similar platforms for documentation review and data extraction.
- Support the development of reports on clinical performance metrics using Microsoft Office tools to inform leadership decision-making.
- Participate in case management activities including discharge planning and coordination of patient care transitions within hospital or nursing home environments.
- Assist in training staff on clinical documentation standards, medical terminology, anatomy knowledge, physiology concepts, and health information management best practices.
Experience
- Proven experience in clinical quality improvement or outcomes coordination within an outpatient setting.
- Strong background in managed care environments with familiarity of Medicaid regulations.
- Hands-on experience with Athena EHR
- Knowledge of medical coding including CPT, ICD-9/10 coding systems along with DRG classification is required.
- Experience in utilization review, medical management, discharge planning or case management is preferred.
- Familiarity with health regulation policies including HIPAA privacy rules and state healthcare laws will ensure compliance excellence.
- Excellent understanding of medical terminology, anatomy, physiology concepts related to inpatient/outpatient care settings including pediatrics or emergency medicine is advantageous.
Join us to be a key driver of clinical quality excellence! Your expertise will empower better patient outcomes while advancing your career in a supportive environment committed to innovation and continuous improvement.
Pay: $50,000.00 - $72,586.96 per year
Benefits:
- 401(k)
- Health insurance
- Life insurance
- Paid time off
Education:
Experience:
- Healthcare: 3 years (Required)
- Clinical Quality: 1 year (Required)
Work Location: In person
