Job Description

Posted Date: 11/19/2019

Position Purpose:

The Quality Navigator position is a Steward Medical Group (SMG) practice based position, responsible for monitoring Blue Cross Blue Shield (BCBS) quality as well as future quality contracts that are added to the Louisiana market. The Quality Navigator will work closely with practice clinical staff and champion driving quality metrics performance.

Key Responsibilities:

  • Onboard new SMG PCP providers into Louisiana quality programs and performance initiatives.
  • Champion quality performance for any new contracts we add with other payors.
  • This position would also periodically review and implement clinical processes and EMR templates in order to improve quality data scoring and capturing.
  • FTE would work directly w/ our quality payors w/ periodic meetings/calls to improve communication and performance of our SMG providers.
  • Develops strong working relationships with SMG clinical practice staff to close gaps in care for patients to improve quality scores.
  • Uses data and clinical expertise to drive program performance communicating with key internal and external stakeholder’s to assist in continually improving clinical care and performance using best practices. Maintain/improve quality scores of current SMG providers, w/ initial focus on BCBS LA quality contract.
  • Meets regularly with internal / external staff to review data and develop strategies that drive continuous improvement.
  • Works with management and is responsible for monthly performance targets based on real time metrics as well as claims based data.
  • Assists key stakeholders in implementing care via partnered and preferred agencies.
  • Demonstrates leadership that creates and fosters a culture of continuous improvement.
  • Performs all job functions in compliance with applicable federal, state, local, and company policies and procedures.
  • Other duties as assigned.

Education:

  • Certified LPN or RN
  • Broad clinical background desired

Years of Experience:

  • Minimum three-five years’ experience in care management role (preferably in a physician practice setting)

Specialized Knowledge:

  • Self-starter able to work as an individual contributor and as part of a team
  • Demonstrated ability to interact with and influence internal and external key stakeholders
  • Excellent critical-thinking, observation, written /verbal skills, problem-solving, and analytical skills.
  • Ability to lead and motivate others to execute a plan in a rapidly changing environment.
  • Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes. Highly organized and ability to work autonomously.
  • Knowledge of leading practice in clinical care and payer requirements.
  • Ability to use Microsoft Office tools including Word PowerPoint, Excel, and Outlook.
  • EHR proficient.

Application Instructions

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