Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA * Provides support to the Quality Management Department by working with members and network ...
Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA * Provides support to the Quality Management Department by working with members and network ...
Healthcare HEDIS/Quality Operations Coordinator
Roseburg, OR · On-site
$22 - $28/hr
Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA * Provides support to the Quality Management Department by working with members and network ...
Healthcare HEDIS/Quality Operations Coordinator
Roseburg, OR · On-site
$22 - $28/hr
Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA * Provides support to the Quality Management Department by working with members and network ...
This role demands proactive oversight of health plan operations including member eligibility, claims processing, and vendor coordination to ensure efficient and effective service delivery in line ...
Quick apply
This role demands proactive oversight of health plan operations including member eligibility, claims processing, and vendor coordination to ensure efficient and effective service delivery in line ...
Be Seen First
Concurrent Utilization Review (UR) Nurse
OR · Remote
$30 - $38/hr
This role involves assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, and ensuring compliance with health plan policies ...
Quick apply
Be Seen First
Concurrent Utilization Review (UR) Nurse
OR · Remote
$30 - $38/hr
This role involves assessing inpatient admission and continued stays, coordinating with healthcare providers, facilitating communication with payers, and ensuring compliance with health plan policies ...
Remote Prior Authorization Pharmacist
OR · Remote
$59/hr
... and health plan benefits. In this fast-paced, high-volume environment, the pharmacist works closely with physicians, healthcare providers, pharmacy technicians, and internal teams to gather and ...
Quick apply
Remote Prior Authorization Pharmacist
OR · Remote
$59/hr
... and health plan benefits. In this fast-paced, high-volume environment, the pharmacist works closely with physicians, healthcare providers, pharmacy technicians, and internal teams to gather and ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site +1
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Nurse Practitioner (Per Diem) ***$3,500.00 Sign-on bonus***
Roseburg, OR · On-site
$2.4K - $10K/mo
Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial * Ability to multitask * Excellent customer service skills * Bi-lingual or multi-lingual a plus * Ability to practice ...
Member Engagement Specialist - Part-time!
$19.14 - $24/hr
Research, verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility * Outreach members by phone to complete Health Risk Assessments * Complete tracking and status ...
Member Engagement Specialist - Part-time!
$19.14 - $24/hr
Research, verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility * Outreach members by phone to complete Health Risk Assessments * Complete tracking and status ...
Research, verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility * Outreach members by phone to complete Health Risk Assessments * Complete tracking and status ...
Research, verify and resolve inquiries relating to Oregon Health Plan and Advanced Health eligibility * Outreach members by phone to complete Health Risk Assessments * Complete tracking and status ...
Patient Services Representative
$18 - $21/hr
... Health Plan, Medicare, and commercial plans Collect and process patient co-pays and other payments Assist patients with basic billing questions and refer to complex issues appropriately Support ...
Patient Services Representative
$18 - $21/hr
... Health Plan, Medicare, and commercial plans Collect and process patient co-pays and other payments Assist patients with basic billing questions and refer to complex issues appropriately Support ...
Behavioral Health Consultant - Primary Care Behavioral Health
Roseburg, OR · On-site
$76K - $94K/yr
Retirement Plan with Employer Match * Company-paid Malpractice, AD&D, and Long-Term Disability ... Primary Care Behavioral Health Location: Roseburg, OR 97470 Job Type: Full-Time | Integrated ...
Quick apply
Behavioral Health Consultant - Primary Care Behavioral Health
Roseburg, OR · On-site
$76K - $94K/yr
Retirement Plan with Employer Match * Company-paid Malpractice, AD&D, and Long-Term Disability ... Primary Care Behavioral Health Location: Roseburg, OR 97470 Job Type: Full-Time | Integrated ...
Health Plan information
What is a health plan?
What are the key skills and qualifications needed to thrive as a health plan manager, and why are they important?
What are some common challenges faced by professionals working in health plan administration, and how can they be effectively managed?
What is the difference between Health Plan vs Health Insurance Coordinator?
| Aspect | Health Plan | Health Insurance Coordinator |
|---|---|---|
| Credentials | Varies; often includes insurance or healthcare administration certifications | Typically requires insurance licensing or certification |
| Work Environment | Insurance companies, healthcare organizations, government agencies | Insurance companies, healthcare providers, broker offices |
| Employer & Industry Usage | Used by organizations managing healthcare benefits | Used by insurance firms coordinating policies and claims |
| Search & Comparison Intent | Understanding healthcare benefit options and plans | Managing and coordinating insurance policies and claims |
While both roles relate to healthcare coverage, a Health Plan typically refers to the actual healthcare benefits or coverage options provided by insurers or employers. In contrast, a Health Insurance Coordinator focuses on managing, processing, and coordinating insurance policies and claims within organizations. Understanding these differences helps clarify career paths and job functions in the healthcare industry.

Healthcare HEDIS/Quality Operations Coordinator
Roseburg, OR
6.6
Based on 5 frontline employees who took The Breakroom Quiz
$22 - $28/hr
Full-time
Posted 13 days ago
Job description
The Regional Quality Coordinator role is responsible of managing Quality operational support initiatives while overseeing special projects, with a focus on supporting HEDIS and Pharmacy gap closures. This position requires daily problem-solving, meticulous tracking, and coordination across departments to meet varying and changing requirements. The RQC will oversee assigned affiliate groups, providing Quality operational support to clinics to achieve their goals, which may include engaging with internal and external stakeholders with in-person and telephonic outreach to patients for education and engagement on preventative screenings, data mining, medication adherence, and follow-up with primary care providers. This position may directly interact with patients to complete tasks for quality gap closure.
The Regional Quality Coordinator will support the assigned market under the direction of the market VP with the assistance of the National Quality Manager.
Essential Functions- Understands the principles of CMS, HEDIS, NCQA, Health Plan Quality Standards, CAHPS, HOS, and HIPAA
- Provides support to the Quality Management Department by working with members and network providers to improve quality of care through quality activities such as HEDIS, CMS Star Rating, and other quality performance reporting
- Provides telephonic outreach to patients, providers, and pharmacies to discuss opportunities for optimizing medication use or other opportunities for improvement of healthcare performance measure related issues
- Improves patient experience and transitions for better healthcare outcomes through quality care
- Participates in data collecting through medical record and claims surveillance
- Works to maximize health plan and healthcare provider performance on healthcare related quality measures through effective telehealth communication with patients and coordination with patient caregivers, providers, and pharmacies.
- Assists in planning, implementing, and executing projects to improve quality and delivery of care services
- Using research and knowledge, identifies potential interventions to improve quality strategies
- Participates in Quality Management meetings and other initiatives
- Prepares quality information for presentation to affiliate groups, including groups current standings relative to others and opportunities or improvement
- Point of Contact for provider groups designated by leader
- Leads project management of Quality Fairs, Diabetic Days, and P3 events to maximize quality gap closure
- Subject Matter Expert in P3 machines (diabetic eye camera, bone density machine, etc.)
- Responds to health plan, provider and interdepartmental calls in accordance with exceptional customer service
- Reviews provider group gap uploads through the P3 Provider portal
- Other duties as assigned
- High school diploma/GED required, associate degree in related field or equivalent experience preferred.
- 2+ years experience in healthcare-related fields required, clinical health care related experience, managed care, or Health plan experience strongly preferred.
- Experience with Microsoft Word, Excel, Power Point, Outlook and general office equipment such as copier, fax machine, required.
- Experience in Electronic Health Records required.
- Medical Assistant Certification or experience as a Pharmacy Tech, Radiology Tech, Lab Tech or similar strongly preferred.
- Experience with data mining is preferred.
- Medical terminology knowledge required, experience with CPT II codes preferred.
- Availability to travel within assigned region and work from multiple providers offices as needed.
- Must have a valid driver’s license, safe driving record, and able to furnish reliable transportation.
This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.
Pay range per hour: $22 - $28 based on experience
About P3People. Passion. Purpose.At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients.
We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance.
We are looking for a Regional Quality Coordinator. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.
About P3 Health Partners
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
51 - 200 Employees
Headquarters location
Henderson, NV, US
Year founded
2015