Job Description

Job Summary

We are seeking a compassionate and organized Transition of Care Clinical Support team member to support patients as they move from hospital to home. In this role, you will conduct post-discharge phone interviews to assess patient needs, identify potential barriers to recovery, and help schedule timely follow-up appointments to reduce hospital readmissions. Ideal candidates are patient-focused, detail-oriented, and comfortable with phone-based patient interactions in a fast-paced healthcare environment. Must have a clinical background, RN, LPN, CMA etc. 

Essential Functions

Implements and monitors quality improvement initiatives to ensure adherence to best practices, policies, and regulatory requirements. Supports teams as a subject matter expert on quality-related workflows, ensuring staff adherence to established procedures. Coordinates and tracks patient outreach efforts to close gaps in care, ensuring timely follow-up on quality attribution reports. Optimizes provider schedules by ensuring appointments address preventive care and chronic disease management gaps. Monitors and analyzes key performance indicators (KPIs) related to quality measures, providing feedback and accountability to stakeholders. Conducts regular rounding with providers and staff to reinforce best practices and identify workflow improvement opportunities. Assists in medical record audits, ensuring compliance with payer requirements and timely submission of quality-related documentation. Facilitates training sessions and provides ongoing support to enhance staff competency in quality care initiatives. Collaborates with data analytics and population health teams to ensure accurate reporting and performance tracking. Maintains compliance with all payer-specific quality programs, ensuring proper documentation and adherence to incentive program requirements. Performs other duties as assigned. Complies with all policies and standards.

Qualifications

Associate Degree in Healthcare Administration, Nursing, Public Health, or a related field required Bachelor's Degree in Nursing or a related field preferred 2-4 years of experience in quality improvement, population health, or clinical operations within a healthcare setting required Experience in working with payer quality programs and regulatory reporting preferred

Knowledge, Skills and Abilities

Strong knowledge of quality improvement methodologies and healthcare regulatory requirements. Proficiency in electronic medical records (EMR) systems and quality reporting tools. Excellent communication and interpersonal skills to collaborate effectively with providers, staff, and leadership. Ability to analyze data, identify trends, and develop action plans for performance improvement. Strong organizational skills and attention to detail to ensure compliance with quality initiatives. Ability to adapt to evolving healthcare regulations and payer requirements. Strong problem-solving skills and the ability to drive accountability in a healthcare setting.

Licenses and Certifications

Certified Medical Assistant (CMA)-AAMA preferred or LPN - Licensed Practical Nurse - State Licensure preferred or RN - Registered Nurse - State Licensure and/or Compact State Licensure preferred CPHQ - Certified Professional in Healthcare Quality preferred