Sunshine Health · 10 hours ago
Provider Quality Liaison
United States
Full-time
Remote
Entry Level
$19.43/hr - $32.98/hr
2+ years expSunshine Health is a diversified national organization focused on transforming the health of communities. The Provider Quality Liaison will connect with plan providers to enhance quality initiatives and performance indicators, providing support and education on quality measures and collaborating on quality improvement interventions.
Hospital & Health Care
Responsibilities
References and connects providers with existing resources to educate provider practices in appropriate HEDIS (Healthcare Effectiveness Data and Information Set) measures, medical record documentation guidelines and Member Experience measures
Acts as an ongoing resource to providers for quality improvement via regular touch points and meetings
Educates, supports, and resolves provider practice sites issues around P4P (Pay for Performance), Rx Effect, CAHPS (Consumer Assessment of Healthcare Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare), Disenrollments, Appeals, and Grievances
Collaborates with Provider Relations and other provider facing teams to improve provider performance in Quality (Clinical and Member Experience measures). Provides clear insight into provider group dynamics, identifies areas of opportunity, builds action plan and collaborates cross functionally to support quality performance
Develops, enhances and maintains provider relationship across all product lines (Medicare, Medicaid, Ambetter). Supports the development and implementation of quality improvement interventions in relation to Plan providers
Conducts telephonic outreach to members to encourage members to visit the physician in an effort to close quality care gaps
Performs other duties as assigned
Complies with all policies and standards
Qualification
Required
Must Reside in FL
Quality / HEDIS Measure
Excellent Customer Service and Communication Skills
Attention to Details
Microsoft Applications
Ability to Build Trusting Relationships with Provider Groups
High school diploma or equivalent
2+ years of experience with clinical and member experience quality
Driver's License required
Preferred
Associate's degree
Pharmacy Technician
Medical Assistant
Licensed Vocational Nurse
Licensed Practical Nurse
Social Work licensure
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Company
Sunshine Health
Headquartered in Broward County, Sunshine Health is among the largest healthcare plans in Florida.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Dwanna Hill
Provider Partnership Manager
Katherine Gomez
Provider Partnership Account Manager
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