Come and join the RMC Family!
We have been in the community since 1935. Our mission is to provide comprehensive multi-specialty medical services in the greater Riverside region. Your passion, inspiration, and talents are invaluable to us and our mission to serve others. Our facility can provide a place for you to thrive and continue your professional development. Quality Healthcare is our passion, improving lives is our reward. We are working to change lives and transform the delivery of healthcare.
Riverside Medical Clinic is the best place to work, practice medicine, and receive care.
SUMMARY: This position is responsible for the coordination of HEDIS and STARs data gathering process. This evaluates the quality and completeness of clinical documentation processes by performing quality medical record reviews, assisting in the improvement of the clinical documentation process, identifying trends, maintaining accurate records of review activities, ensures all data submitted to the health plan meets the HEDIS / Star technical specifications for medical records. Other duties within the QM department may be assigned to the QM Coordinator based on department needs.
QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential function satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
HOURS: Monday - Friday, 830a - 530p
QualificationsEDUCATION and/or EXPERIENCE: High school diploma or GED required. Preferably two to three (2-3) years' experience in the healthcare field. Associate's degree preferred.
CERTIFICATES, LICENSES, AND REGISTRATIONS: None.
ESSENTIAL FUNCTIONS:
Essential functions are those tasks, duties and responsibilities that comprise the means of accomplishing the job's purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Note: (other duties may be assigned, deleted or changed at any time, at the discretion of management, formally, or informally, either verbally or in writing).
1. Work closely with health plan partners to close HEDIS measure care gaps.
2. Process grievances, appeals and complaints.
3. Complete Peer Review Evaluations, initiate Provider Medical Record Audits, and process incident reports.
4. Report hospital transfers from ASC based on regulatory requirements. Analyze data and conduct root cause analysis.
5. Complete data entry in an accurate and timely manner.
6. Maintain the privacy of both internal and external clients.
OTHER RESPONSBILITIES:
1. Uphold and support the mission, philosophy, objectives, and policies of Riverside Medical Clinic.
2. Assume responsibility for initiating a pleasant patient-oriented atmosphere by displaying a professional attitude through performance, appearance, and demeanor.
3. Maintain work area in a clean and orderly manner and in accordance with facilities policy.
4. Annually participate and complete required health screening.
5. Adhere to Safety Program as outlined in Core Competencies and Injury, Illness and Prevention Program.
6. Maintains professional composure and confidence during stressful situations.
7. Maintains open communication using appropriate chain of command regarding issues.
8. Presents neat appearance in proper attire and identification as required by the position, department and RMC policy.
9. Continuously displays a positive, "can do" attitude within the department and across departmental lines to contribute to the overall customer service program in place at Riverside Medical Clinic.
This opportunity offers the following:
Challenging and rewarding work environment
Growth and Development Opportunities within UHS and its Subsidiaries
Competitive Compensation
About Universal Health Services
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Avoid and Report Recruitment Scams
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.
If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.