Senior Clinical Integration Analyst
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond.
As a joined force of people caring for people, Martin's Point employees are on a mission to transform our health care system while creating a healthier community.
Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.
Join us and find out for yourself why Martin's Point has been certified as a Great Place to Work since 2015.
Position Summary The Senior Clinical Integration Analyst role works collaboratively with members of the Clinical Integration Team to provide administrative assistance, operational support, and coordination.
This role performs internal/external customer support activities and supports the daily coordination of the Population Health (PHN) RN team and/or centralized Outreach team efforts (Clinical Integration Associate and Analyst), ensuring daily operational functions of the teams are met in a timely and accurate manner in compliance with contractual and regulatory standards set forth by our individual payor contracts and NCQA.
Job Description Key Outcomes:
Increases clinical quality gap closure through the daily coordination of Outreach team activities to maximize team efficiency and overall payor contract performance.
Including but not limited to the following areas of focus:
Review of electronic health record to identify and verify clinical visit or quality gap status in preparation for centralized outreach efforts.
Outbound calls to patient/members for engagement in contractual goal-based visit scheduling or identified gap closure efforts.
Inbound call handling of patient/member call-backs for quality initiative outreach work.
Reviews electronic health records to support gathering of supplementary documentation for submission to payors or 3rd party vendors in support of delivery system quality and code recapture efforts.
Attends Quality Optimization Committee meetings to support increased understanding and alignment of quality efforts with contractual goals to maximize organizational quality and financial performance.
Manages electronic health record clinical documents for the PHN team to support team efficiency in the coordination and completion of post-discharge call efforts and complex care navigation touches.
Performs medallion census management to support timely Population Health Nurse post-discharge outreach, per organizational guidelines to support an effective intervention that results in reduction in readmission rates and integrity of health information during the transitional period.
Tracks upcoming appointments during inpatient status to reduce delivery system no shows.
Audits and reviews external Maine Health Management Coalition and MaineCare data to ensure it is accurate and inclusive.
Assists with National Committee for Quality Assurance (NCQA) documentation, as needed to support ongoing compliance and recertification efforts.
.
Performs data entry into the electronic health record, including document labeling and the updating of demographic are care team sections.
Performs or assists with tracking and trending data as needed.
Supports patient/member attribution reconciliation efforts with our payers.
Performs outreach to community facilities and specialty offices:
gathering pertinent clinical updates on patient/members, verification of inpatient status, support appointment scheduling, and request documentation for care management coordination or clinical quality gap closure efforts.
Supports care management program referral and intake support (ICC, Medtronic, CCT, etc.
).
Organizes, leads, or participates in daily huddles and regular team meetings to improve workflows and contribute to improving Clinical Integration Team efforts.
Develops and maintains departmental standard work, scripting or departmental processes for initiatives as directed.
Supports Clinical Integration Department team member experience through communication and activity coordination, scheduling and coordinating team meetings and taking minutes as directed
Orders educational materials and departmental supplies.
Education/
Experience:
High School Diploma required
Associates Degree or equivalent combination of education and experience strongly recommended
Bachelors Degree preferred
3
years working in a health care environmentRequired License(s) and/or Certification(s):
Medical Assistant Certification preferred Skills/Knowledge/Competencies (Behaviors):
Strong proficiency in medical terminology knowledge.
Strong understanding of confidentiality and the legal and ethical issues pertaining to it surrounding coordination of care and service delivery.
Comfort and strength in developing professional and trusting relationships with community resources.
Participation and engagement in continual improvement process and regular team meetings.
Proficient in the use of Microsoft Excel and Word; technical skills in use of electronic health records and databases.
Excellent interpersonal, verbal, and written communication skills.
Ability to work independently and make decisions.
Ability to produce high quality work in a high-pressure environment.
Basic knowledge of transitional care management.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martins Point Health Care? Contact us at:
email protected Martins Point Health Care is a progressive, not-for-profit organization providing primary care and health insurance plans to the people of Maine and beyond.
The organization owns and operates seven primary care health care centers with over 70 health care providers in Maine and New Hampshire and accepts most major insurance plans.
Martins Point also administers two health plans:
Generations Advantage, the largest Medicare Advantage plan in Maine, and the US Family Health Plan (TRICARE Prime) for military families and retirees throughout New England.
For more information, visit https:
//careers.
martinspoint.
org.
Recommended Skills Auditing Business Process Improvement Clinical Works Confidentiality Customer Service Data Entry Estimated Salary: $20 to $28 per hour based on qualifications.
As a joined force of people caring for people, Martin's Point employees are on a mission to transform our health care system while creating a healthier community.
Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day.
Join us and find out for yourself why Martin's Point has been certified as a Great Place to Work since 2015.
Position Summary The Senior Clinical Integration Analyst role works collaboratively with members of the Clinical Integration Team to provide administrative assistance, operational support, and coordination.
This role performs internal/external customer support activities and supports the daily coordination of the Population Health (PHN) RN team and/or centralized Outreach team efforts (Clinical Integration Associate and Analyst), ensuring daily operational functions of the teams are met in a timely and accurate manner in compliance with contractual and regulatory standards set forth by our individual payor contracts and NCQA.
Job Description Key Outcomes:
Increases clinical quality gap closure through the daily coordination of Outreach team activities to maximize team efficiency and overall payor contract performance.
Including but not limited to the following areas of focus:
Review of electronic health record to identify and verify clinical visit or quality gap status in preparation for centralized outreach efforts.
Outbound calls to patient/members for engagement in contractual goal-based visit scheduling or identified gap closure efforts.
Inbound call handling of patient/member call-backs for quality initiative outreach work.
Reviews electronic health records to support gathering of supplementary documentation for submission to payors or 3rd party vendors in support of delivery system quality and code recapture efforts.
Attends Quality Optimization Committee meetings to support increased understanding and alignment of quality efforts with contractual goals to maximize organizational quality and financial performance.
Manages electronic health record clinical documents for the PHN team to support team efficiency in the coordination and completion of post-discharge call efforts and complex care navigation touches.
Performs medallion census management to support timely Population Health Nurse post-discharge outreach, per organizational guidelines to support an effective intervention that results in reduction in readmission rates and integrity of health information during the transitional period.
Tracks upcoming appointments during inpatient status to reduce delivery system no shows.
Audits and reviews external Maine Health Management Coalition and MaineCare data to ensure it is accurate and inclusive.
Assists with National Committee for Quality Assurance (NCQA) documentation, as needed to support ongoing compliance and recertification efforts.
.
Performs data entry into the electronic health record, including document labeling and the updating of demographic are care team sections.
Performs or assists with tracking and trending data as needed.
Supports patient/member attribution reconciliation efforts with our payers.
Performs outreach to community facilities and specialty offices:
gathering pertinent clinical updates on patient/members, verification of inpatient status, support appointment scheduling, and request documentation for care management coordination or clinical quality gap closure efforts.
Supports care management program referral and intake support (ICC, Medtronic, CCT, etc.
).
Organizes, leads, or participates in daily huddles and regular team meetings to improve workflows and contribute to improving Clinical Integration Team efforts.
Develops and maintains departmental standard work, scripting or departmental processes for initiatives as directed.
Supports Clinical Integration Department team member experience through communication and activity coordination, scheduling and coordinating team meetings and taking minutes as directed
Orders educational materials and departmental supplies.
Education/
Experience:
High School Diploma required
Associates Degree or equivalent combination of education and experience strongly recommended
Bachelors Degree preferred
3
years working in a health care environmentRequired License(s) and/or Certification(s):
Medical Assistant Certification preferred Skills/Knowledge/Competencies (Behaviors):
Strong proficiency in medical terminology knowledge.
Strong understanding of confidentiality and the legal and ethical issues pertaining to it surrounding coordination of care and service delivery.
Comfort and strength in developing professional and trusting relationships with community resources.
Participation and engagement in continual improvement process and regular team meetings.
Proficient in the use of Microsoft Excel and Word; technical skills in use of electronic health records and databases.
Excellent interpersonal, verbal, and written communication skills.
Ability to work independently and make decisions.
Ability to produce high quality work in a high-pressure environment.
Basic knowledge of transitional care management.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martins Point Health Care? Contact us at:
email protected Martins Point Health Care is a progressive, not-for-profit organization providing primary care and health insurance plans to the people of Maine and beyond.
The organization owns and operates seven primary care health care centers with over 70 health care providers in Maine and New Hampshire and accepts most major insurance plans.
Martins Point also administers two health plans:
Generations Advantage, the largest Medicare Advantage plan in Maine, and the US Family Health Plan (TRICARE Prime) for military families and retirees throughout New England.
For more information, visit https:
//careers.
martinspoint.
org.
Recommended Skills Auditing Business Process Improvement Clinical Works Confidentiality Customer Service Data Entry Estimated Salary: $20 to $28 per hour based on qualifications.
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