Analysis Skills, Analysis Software, Chronic Disease, Clinical Support, Community Health, Continuous Improvement, Data Analysis, Data Collection, Data Entry, Detail Oriented, Discrepancy Report, Disease Prevention and Control, Documentation, Gap Closure, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), High School Diploma, Interpersonal Skills, Leadership, Medical Record System, Microsoft Excel, Microsoft Office, Multitasking, Nursing, Patient Charts, Presentation/Verbal Skills, Problem Solving Skills, Quality Assurance, Quality Management, Quality Metrics, Reconciliation, Requirements Management, Team Player, Treatment Evaluation
POSITION SUMMARY: Under general supervision from the Quality Assurance Manager, the responsibilities of a Health Continuity Specialist reviews gaps in patient care as indicated by GPRA and other relevant measures. The Health Continuity Specialist supports NVIH’s population health initiatives by leading care gap identification, documentation reconciliation, and frontline data collection and analysis.
This position will work in close collaboration with Quality team members, the Community Health & Outreach (CH/OR) Department, the Digital Health Team (DHT), and other internal stakeholders to focus on data entry, tracking, and analysis improvement efforts, as well as gap closure efforts, including potential direct outreach to patients.
ESSENTIAL JOB FUNCTIONS: The list that follows is not intended as a comprehensive list, but rather to provide a representative summary of the major duties and responsibilities. Incumbent(s) will be required to perform a variety of duties listed, including but not limited to:
- Care Gap Identification & Data Reconciliation
- Review internal and external reporting platforms (e.g., HEDIS, GPRA, etc.) to identify and reconcile gaps in preventive and chronic disease care; health screenings; and other population health management areas.
- Audit patient charts within the EHR to validate documentation accuracy and ensure services are captured appropriately for quality reporting.
- Reconcile discrepancies between external reports and internal EHR data through detailed chart review and crosswalk tracking tools.
- Engage in gap closure efforts, including potential direct outreach to patients.
- Documentation Integrity & Workflow Support
- Collaborate with internal stakeholders including providers, nursing staff, Quality team members, and others to address documentation efficiency and improve chart accuracy.
- Identify recurring documentation or workflow challenges and communicate these findings to leadership.
- Quality Reporting Support
- Monitor and communicate internal gap identification via chart audits and reconciliation of external vs. internal data.
- Utilize organization and analysis software to understand patterns in care gaps and data discrepancies over time.
- Assist in collecting baseline data, tracking interventions, and monitoring measurable outcomes following quality improvement efforts.
- Support the Quality team in analyzing and reporting on Patient Satisfaction Surveys.
- Internal & External Collaboration
- Attend internal and external quality-related meetings as requested.
- Engage with internal stakeholders to foster a culture of continuous improvement within NVIH.
- Serve as a positive and professional representative of the Quality team both within NVIH and externally.
- Other duties as assigned.
Keyword: Health Continuity Specialist
Required Experience:
REQUIRED QUALIFICATIONS: The following knowledge, skills, and abilities are required for an employee to successfully perform their duties.
- High school diploma or GED equivalent; Associate’s degree preferred.
- Healthcare Industry experience required: One (1) years in clinical support, data analysis, patient navigation, or other quality-related role strongly preferred.
- Knowledge of chronic disease management concepts, basic reporting requirements, and data analysis.
- Technical Knowledge: Experience working within an Electronic Health Record (EHR) is required. Proficiency with Microsoft Office Suite, specifically Excel in performing data tracking and list management is required.
- Strong interpersonal and collaborative skills, including effective written and verbal communication with a variety of stakeholders.
- Demonstrated ability to handle competing priorities simultaneously.
- Strong analytical, detail-oriented, critical thinking and problem-solving abilities.
- Demonstrated cultural sensitivity when working with Native communities and vulnerable populations.
- Reliable transportation and ability to adhere to regular attendance.
Native Preference. Northern Valley Indian Health provides Native Preference in hiring practices for qualified Native applicants, in accordance with its policy. NVIH is also an Equal Opportunity and At Will Employer.
Benefits:
14 Paid Holidays
Medical, Dental, Vision Coverage
Flex Scheduling
401K Matching
Generous PTO
From: Northern Valley Indian HealthN
Northern Valley Indian Health