Quality Coordinator II - Advanced Primary Care Management

Job Details: Job Location: VHC Elkins - Elkins, WV, Position Type: Full Time, Salary Range: Undisclosed, Travel Percentage: Up to 25%, Job Shift: Day, Job Category: Health Care, Job SummaryThe Quality Coordinator II provides non-face-to-face Advanced Primary Care Management (APCM) services to patients with chronic conditions. This role supports improved patient outcomes by coordinating care, promoting patient engagement, and assisting with the management of chronic conditions in accordance with established care plans and CMS guidelines.The Quality Coordinator II works collaboratively with providers, clinical staff, and care teams to ensure appropriate care coordination, support quality performance measures, and reduce avoidable healthcare utilization such as emergency department visits and hospitalizations. Responsibilities include monitoring patient progress, facilitating communication between patients and care teams, assisting with care plan implementation, and maintaining accurate documentation of services provided under the APCM program. This position plays an essential role in advancing value-based care initiatives by supporting population health management and ensuring compliance with Centers for Medicare & Medicaid Services (CMS) program requirements.Essential Duties and ResponsibilitiesAPCM Program Management Identify and enroll eligible patients in the APCM program and obtain consent Develop, update, and maintain comprehensive care plans Conduct timely APCM outreach and document per CMS guidelines Monitor chronic conditions, medication adherence, and patient goals Coordinate care with providers, specialists, and community partnersTCM Program Management Receive and review hospital and ED discharge reports daily Conduct patient outreach within required timeframes (2 business days) Perform medication reconciliation and assess post-discharge needs Schedule and coordinate timely follow-up appointments Identify barriers to care and coordinate needed servicesDocumentation & Quality Support Accurately document APCM and TCM activities in the EHR per CMS guidelines Ensure documentation supports CMS billing and compliance Identify care gaps and collaborate with Quality Coordinator I to close them Track TCM outcomes, follow-up completion, and readmissions Collaborate with providers and hospitals to ensure continuity of care Support quality reporting related to readmission and follow-up measures Support quality improvement initiatives related to chronic disease measuresQualifications: Education and Experience Active West Virginia LPN/RN License Required Experience in care management, population health, or chronic disease management preferred Knowledge of CMS APCM, and TCM billing and documentation requirements preferred Strong patient education and care coordination skills Requires strong computer skills.Professional Standards Leadership  Team building mentality is exemplified in all work done.  Positively influence and uplift members and other affiliates.  Employee Expectations  Follow all policies and procedures, including the Code of Conduct, which can be found in the Employee Handbook.  Follow the direction given by the supervisor to ensure site expectations are met.  Communication  Must be able to provide important and relevant site information in staff meetings and to members, co-workers, and supervisors.  Must be able to listen to co-workers and team members.  Must be able to present important and relevant site information to supervisors.  Must be able to write and compose clear, concise, accurate written documentation and data reports, as necessary.  ValuesUpholds the Code of Ethics and mission of Valley Health Care, Inc. by conducting professional activities with Valley Health Care’s values of integrity, teamwork, compassion, excellence, and Here for Good.     Integrity          We act openly and truthfully in everything we do.     Teamwork          We work together to serve our patients.     ExcellenceWe create better ways of doing the things we do and provide the highest quality of care for each patient every time.     Compassion         We treat each other and our patients with concern, kindness, and respect.     Here for Good                We make decisions that will best serve our patients now and in the future.Understanding of Health Care Laws and Regulations Must have the ability to follow HIPAA guidelines as well as an understanding of policies and procedures regarding medical records put in place by the Federal Government, Medicaid, Medicare, and WV Behavioral Health Laws put forth by the WV Department of Health and Human Resources. Customer ServiceMust listen to the customer, understand the customer, do what needs to be done to meet the customer’s expectations, and take ownership of the customer experience.Computer LiteracyKnowledge of basic computer software (MS Office – Word, Excel, and Outlook) and the willingness and ability to learn electronic medical records software. Reasoning AbilityMust demonstrate the ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret various instructions furnished in written, oral, diagram, or schedule form.TeamworkAn essential element is the ability to work and interact effectively and positively with other staff members to build and enhance teamwork in the VHC organization; team engagement is necessary to be successful in this position. Work RecordA demonstrated work record showing good attendance, punctuality, dependability, and the ability to collaborate well with supervisors and coworkers as part of a team effort is essential. A medical office setting is an environment that requires the ability to relate to all types of people while always maintaining a professional demeanor. Language SkillsAbility to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. The ability to write routine reports and correspondence. The ability to speak effectively to patients or employees of the organization. Mathematical SkillsAbility to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Additional SkillsMust be able to read and interpret medical and work environment-related documents involving patient care, program descriptions, government regulations, and VHC policy and procedures. Sensitivity to Needs of Special PopulationsMust be able to demonstrate an understanding and sensitivity to cultural differences and needs of VHC patients and be able to respond appropriately to all people regardless of race, ethnicity, language, age, sex or sexual orientation, religion, disability, economic standing, etc. Physical DemandsThe physical demands described here represent those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may be required to drive, sit and stand for extended periods of time; handle papers, type and operate computer equipment; reach with hands and arms; talk in-person, on the telephone, and by electronic means; see and hear, and lift up to twenty-five pounds. Work EnvironmentWork is performed in a typical outpatient clinic environment and at locations outside the office. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.