What are the responsibilities and job description for the Clinic Quality-ACO Specialist position at Goodland Regional Medical Center?
Job Title: Clinic Quality – ACO Specialist
Classification: Non-Exempt/Hourly
Reports To: Clinic Coordinator
Position Type: Full-Time
Hours Worked/Shift: Monday - Friday
Summary:
The primary objective of this role is to support the healthcare organizations (Goodland Family Health Center and Rawlins Clinic-Atwood) in meeting value-based care goals, which involves improving patient outcomes and care coordination while managing costs and ensuring compliance with regulatory requirements. Coordinates and schedules patient appointments with an added emphasis on preventative care, care coordination and population health management goals specific to the Accountable Care Organization (ACO) model. The role requires managing appointment logistics while also supporting initiatives to improve overall patient outcomes and efficiency across a network of providers.
Essential Functions:
1.
Proactive Quality Outreach: Identifies, prioritizes, and proactively schedules patients due for preventive screenings (e.g., mammograms, colonoscopies, immunizations) and chronic care follow-ups using population health registries/EHR data to close care gaps and meet specific ACO quality metrics.
2.
Annual Wellness Visit (AWV) Optimization: Manages and schedules eligible patients for their AWVs to maximize preventive care coding and risk adjustment documentation (HCC/RAF score), which is essential for ACO financial stability.
3.
High-Risk Patient Outreach: Identifies and prioritizes scheduling for high-risk patients, including those recently discharged (follow-up within 7-14 days) or those with multiple chronic conditions, to prevent readmissions and costly Emergency Department (ED) visits.
4.
Interdisciplinary Coordination: Coordinates appointments, referrals, labs, and follow-up activities to ensure consistent and timely care across the continuum of care, consulting with other departments and clinical teams as needed.
5.
Metric-Driven Documentation: Ensures all scheduling notes clearly indicate the reason for the appointment relates to an ACO quality metric (e.g., "Outreach for Diabetic Retinal Exam"), supporting accurate coding and capture of services provided.
6.
Refusal and Compliance Documentation: Accurately documents patient refusals for care, screenings, or AWVs using standardized templates within the EHR to ensure proper compliance reporting or to facilitate future outreach efforts.
7.
Reporting and Process Improvement: Reports on the progress of care gap closures and scheduling challenges to clinical and administrative leadership to inform continuous process improvement in ACO initiatives.
8.
Communication Strategies: Utilizes specific tools and engaging communication strategies (phone, text, email) for accurate and effective outreach to patients and communication with ACO teams.
Clinic Quality – ACO Specialist pg. 2
9.
Professional Conduct: Maintains a professional, customer-friendly environment that treats patients and families with respect and dignity, fostering positive public relations for the organization.
10.
Policy Adherence: Meets all organizational policies and procedures, including QA, Safety, Infection Control standards, and is responsible for communicating relevant clinic policies to patients and families.
11.
Professional Development: Participates in required in-service training and other opportunities for professional development as assigned by management.
12.
Ability to handle high volume patient outreach with consistent persistence, including managing frequent "no answer" or refusals while maintaining a positive and empathetic demeanor.
13.
Ability to quickly analyze population health reports and prioritize outreach lists based on urgency and maximum impact on ACO performance metrics.
14.
High level of comfort navigating multiple digital platforms simultaneously (EHR, Population Health Tool, scheduling software, communication platforms).
15.
Exceptional ability to clearly and concisely explain the value and necessity of preventive services and chronic care appointments to motivate patient compliance and overcome potential scheduling barriers.
16.
Performs all other duties as may be assigned by management staff.
Competencies:
•
Excellent verbal communication, customer service, active listening, and time-management skills.
•
Strong organizational skills and attention to detail.
•
Working knowledge of electronic health records (EHR) systems software.
•
Advanced knowledge of medical terminology as it relates to preventive services and chronic disease management.
•
Working knowledge of value-based care concepts, quality metrics, and population health management.
Position Qualifications:
Minimum Education: High school diploma or GED required. Associate’s degree in a healthcare related field desirable. Knowledge of medical terminology.
Minimum Experience: Minimum 1-2 years of experience in a medical office, clinic, or hospital setting. Previous experience working with an ACO, Managed Care, or Value-Based Care organization is desirable.
Certifications/Licensures: Medical Assistant (MA) or similar clinical certification is highly desirable.
Working Environment:
Must be comfortable working in a fast-paced, goal-oriented environment where daily performance is measured against specific ACO quality and productivity targets. This position requires significant time dedicated to outbound phone calls and digital outreach.
Physical Demands: **
Stand: Frequently
Walk: Frequently
Sit: Frequently
Squat/Kneel: Occasionally
Bend: Occasionally
Lift/Carry:
0-10 pounds: Occasionally
10-20 pounds: Occasionally
20-50 pounds: Never
50-100 pounds: Never
100 pounds: Never
Push/Pull:
10-25 pounds: Occasionally
25-50 pounds: Occasionally
50-100 pounds: Never
100 pounds: Never
Clinic Quality – ACO Specialist pg. 3
**Reasonable accommodations may be made to enable individuals with disabilities to perform the position accountabilities without compromising patient care or departmental efficiency. However, should it de determined that the employee cannot meet the position accountabilities with or without accommodation, it is the right of GRMC to release the individual under Kansas “Employment at Will” doctrine**
Professional Requirements:
Adheres to policies, procedures, and always maintains confidentiality. Attends annual in-services completes annual education in a timely manner. Represents GRMC in a positive, professional manner on the job, electronically and in the community. Complies with all hospital policies regarding ethical business practices; communicates the mission statement & core values of GRMC both on and off the job.