POSTED: April 19, 2024

POSITION : Diabetes Clinical Coordinator - Quality Management

DEPARTMENT: Clinical Services

POSITION SUMMARY:

Performs assigned clinical functions in accordance with Upper Peninsula Health Plan (UPHP) policies and procedures and all state and federal accrediting and regulatory standards; assists in the management of the health care of all UPHP members through evaluation and implementation of population health management activities related to diabetes; measures effectiveness of these activities through medical record and data review as well as through Michigan Department of Health and Human Services (MDHHS), National Committee for Quality Assurance (NCQA), or Centers for Medicare and Medicaid Services (CMS) reporting.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Follows established UPHP policies and procedures, objectives, safety standards, and sensitivity to confidential information.

2. Performs all assigned tasks in accordance with UPHP plans, policies and procedures, and NCQA and regulatory standards.

3. Implements, evaluates, and develops UPHP population health management activities related to diabetes and other areas of care as assigned. Prepares reports, provider communications, and member communications related to these activities.

4. Conducts regular outreach to members with diabetes to ensure follow-up on referrals, appointments and other health related social needs utilizing phone, email, and direct mailing. Provides education on diabetes self-management, community and health plan programs, and member incentives to promote self-management and improved health outcomes.

5. Serves as a resource for members, their families/guardians, providers, and community-based organizations for diabetes care coordination and UPHP benefit navigation. Collaborates with health professionals internally and externally to plan, implement, and evaluate diabetes care coordination and intervention methods. Participates in community related events to promote health literacy and well-being.

6. Continuously monitors diabetic measure sets. Provides recommendations for process improvement and implementation of interventions related to improving overall member health outcomes.

7. Assures assigned portion of clinical services work plan is completed on an accurate and timely basis.

8. Assists in the development and maintenance of policies and procedures related to respective programs in accordance with regulatory and accrediting standards.

9. Demonstrates knowledge of all clinical MDHHS, CMS, and Department of Insurance and Financial Services (DIFS) standards; all applicable NCQA Utilization Management (UM), Quality Improvement (QI), and Member's Rights and Responsibility (RR) standards; and Healthcare Effectiveness Data and Information Set (HEDIS) measures as they relate to clinical functions and respective programs; assumes responsibility for specific NCQA standards as assigned.

10. Coordinates objectives of designated NCQA Health Plan Accreditation standards.

11. Participates in departmental and interdepartmental process improvements; recommends improvements in clinical processes as opportunities are identified.

12. Serves as backup to other team members in their respective areas in demonstrated times of excessive workload and/or benefit time.

13. Attends and participates in organizational, departmental, and clinical program meetings as required.

14. Maintains confidentiality of client data.

15. Performs other related duties as assigned or requested.

POSITION QUALIFICATIONS:

Education:

Minimum:

Licensed practical nurse or associate degree in nursing or health care-related area

Preferred:

Bachelor's degree in nursing, health education or health-related area; diabetes certification

Requirement:

If nursing degree, licensed in state of Michigan

Experience:

Minimum:

Two (2) years of clinical or health-related experience

Preferred:

Three (3) to five (5) years of clinical experience related to diabetes management and / or health coaching or clinical quality improvement experience

Required Skills:

Keyboarding proficiency and working knowledge of MS Office programs (Word and Excel)

Excellent human relation and oral/written communication

Excellent organizational and prioritization abilities

Desired Skills:

Ability to interpret and analyze data

Working knowledge of MS Office Access and PowerPoint

The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.

Physical Requirements:

[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:

Ability to access departmental files

Ability to enter and access information from a computer

Ability to access all areas of the UPHP offices

Moderate physical effort (lift/carry up to 25 pounds)

Occasionally lifts supplies/equipment

Occasional reaching, stooping, bending, kneeling, crouching

Prolonged periods of sitting

Occasional prolonged standing

Manual dexterity and mobility

Working Conditions:

Works in office conditions, but occasional travel may be required

Subject to many interruptions

Exposure to situations requiring exceptional interpersonal skills or high productivity

Occasionally subjected to irregular hours