Care Coordination Quality and Affordability Specialist

Care Coordination Quality And Affordability Specialist

HealthPartners is hiring a Care Coordination Quality and Affordability Specialist. The Care Coordination Quality and Affordability Specialist supports the Care Coordination program by driving affordability, cost stewardship, and appropriate utilization of Elderly Waiver (EW) and Medicaid services. This role partners with Care Coordinators, HealthPartners leadership, and delegated partners to ensure accurate assessments, effective use of risk scoring and cost data, closure of gaps in care, and consistent application of supports and services aligned with member needs, program requirements, and financial sustainability. The position analyzes MnCHOICES assessments, builds Interrater Reliability (IRR) scenarios, and translates cost and risk insights into actionable guidance that supports high-quality member experience and outcomes.

Minimum Qualifications

• Education, Experience or Equivalent Combination:
• Bachelor's degree in nursing or social work
• Minimum of four (4) years of experience in quality improvement and/or healthcare services
• Demonstrated expertise of Medicaid, Elderly Waiver (EW), LTSS, and Care Coordination programs
• Licensure/Registration/Certification:
• Registered Nurse (RN) or Social Worker (SW)
• MnCHOICES Certified Assessor
• Knowledge, Skills, and Abilities:
• Demonstrated ability to analyze healthcare cost, utilization, and risk data
• Strong data development, analysis, and problem-solving skills
• Ability to plan and execute project deliverables using various methodologies
• Demonstrated leadership and project management capabilities
• Excellent interpersonal communication, facilitation, listening, and feedback skills
• Ability to teach large groups as well as provide individual coaching
• Proficient PC skills, including Microsoft Office products
• Ability to establish and maintain effective working relationships across all organizational levels

Preferred Qualifications

• Education, Experience or Equivalent Combination:
• Experience interpreting MnCHOICES assessments or similar assessment tools
• Knowledge, Skills, and Abilities:
• Ability to translate complex financial, utilization, and risk data into practice-level guidance for frontline staff and leaders

Essential Duties

1. (40%) Cost & Utilization:
• Analyze EW and Medicaid spending patterns, cost drivers, and utilization trends to identify opportunities for improved affordability and appropriate service use while driving quality and best practice outcomes
• Use risk scoring, cost breakdowns, and utilization data to evaluate Care Coordinator assessments and decision-making for alignment with MnCHOICES, program guidelines, appropriate service use, and member needs
2. (30%) Assessment Reliability:
• Build, analyze, and present Interrater Reliability (IRR) scenarios using current MnCHOICES assessments and EW/Medicaid services
• Identify gaps in care and variation in practice and partner with Care Coordination leadership and delegated partners on data-driven improvement strategies
3. (15%) Coaching & Consultation:
• Provide consultation and coaching to Care Coordinators and leaders on cost-effective, member-centered use of supports and services
• Translate complex financial, risk, and utilization data into clear, actionable insights
• Act as a liaison between Care Coordination, quality, finance, and other partners to support system-level affordability and care delivery goals
4. (15%) Initiative Execution:
• Ensure affordability and utilization initiatives are integrated with quality improvement methods and member experience considerations
• Support planning and execution of affordability and utilization initiatives aligned with Care Coordination program goals

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.