Quality Improvement Specialist
Columbia, SC | 10 Months
Quality Improvement Specialist ---- Supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies impacting plan compliance to regulatory and accreditation standards. Interfaces with a diverse range of clinical and administrative professionals. resolves complex issues. and performs data analytic and reporting activities. ---- ESSENTIAL FUNCTIONS ---- Note: The following is not intended to be an exhaustive list of all duties required of this position ---- Key Duties and Responsibilities ---- Monitors quality improvement initiatives including. but not limited to. development and implementation of preventive health and chronic disease outcome improvement interventions such as: newsletter articles. member education and outreach interventions. provider education. member outreach interventions. medical record reviews. focus groups. and surveys.---Monitors and investigates all quality of care and collaborates with medical directors to determine impacts and next steps for actions. Monitors provider quality complaints to identify trends and educational opportunities for improvement.---Analyzes. updates. and modifies procedures and processes to continually improve QI operations.---Collects and summarizes performance data and identifies opportunities for improvement.---Serves as knowledge expert for continuous quality improvement activities. QIPS. PIPs and QIAs.---Monitors and analyzes outcomes to ensure goals. objectives. outcomes. accreditation and regulatory requirements are met.---Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies. CMS. AAAHC. URAC. NCQA.EQRO).---Conducts internal auditing of compliance with regulatory and accreditation standards.---Supports the implementation of the quality reporting infrastructure.---Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics. performs adequate data/barrier analysis. develops improvement recommendations. and deploys actions as approved.---Assists in activities to prioritize clinical and service improvement initiatives.---Participates in various QI committees and work groups convened to improve process and/or health outcomes. and contributes meaningful detail. based on functional knowledge. Completes follow-up as assigned.---Manages and monitors assigned quality studies.---Investigates and incorporates national best practice interventions to affect greater rate increases.---Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.---Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.---Performs other duties as assigned. ---- Additional Position Responsibilities ? Optional ---- Completes Licensed Health Care Risk Management certification program.---Performs annual update on Plan Risk Management Program Description.---Coordinates the regular and systematic review of all potential adverse incidents in accordance with state statute.---Completes AHCA Code 15 Reports for confirmed adverse incidents.---Submits an annual AHCA adverse incident summary report.---Presents summary reports of reported AHCA Code 15 adverse incidents through the quality committee structure and Board of Directors. ---- MINIMUM QUALIFICATIONS ---- Education ---- State the minimum required for the job ---- Education Level Education Details Required/Preferred ---- A High School or GED with a current unrestricted RN license Required---A Bachelor's Degree in Healthcare. Nursing. Health Administration. Public Health or related health field Preferred ---- Work Experience ---- State the minimum required for the job ---- Experience Level Experience Details Required/Preferred ---- 2+ years of experience in Quality Improvement Required---3+ years of experience in Managed Care Required---Other Experience in compliance and accreditation Required---Other Knowledge of federal and state regulations/requirements Required ---- Licenses and Certifications ---- List professional licenses and certifications associated with this job ---- Licenses/Certifications Other Licenses/Certifications Required/Preferred ---- Licensed Registered Nurse (RN) Required ---- Skills ---- State the minimum required for the job ---- Skill Sets Other Skills Proficiency ---- Demonstrated written communication skills Advanced---Demonstrated interpersonal/verbal communication skills Advanced---Ability to multi-task Intermediate---Ability to work in a fast paced environment with changing priorities Intermediate---Ability to effectively present information and respond to questions from families. members. and providers Intermediate---Ability to create. review and interpret treatment plans Advanced---Ability to identify basic problems and procedural irregularities. collect data. establish facts. and draw valid conclusions Intermediate---Knowledge of healthcare delivery Intermediate---Knowledge of community. state and federal laws and resources Intermediate---Demonstrated time management and priority setting skills Intermediate---Ability to implement process improvements Intermediate ---- Technology ---- List technical skills associated with the job ---- Technology Other Technology Proficiency Required/Preferred ---- Microsoft Excel Intermediate Required---Healthcare Management Systems (Generic) Intermediate Required---Microsoft Word Intermediate Required---Microsoft Outlook Intermediate Required ---- Languages ---- List all that apply ---- Languages Other Languages Required/Preferred ---- ---- SCOPE ---- Level of Supervision Received: ---- A statement which describes the level of independence for this position. ---- [X] Plans and arranges own work. refers only unusual cases to supervisors or others. ---- Level of Supervision Exercised: ---- (Select all that apply) Positions Supervised ---- [X] Individual Contributor 1 [ ] (Please check all that apply) ---- Impact: ---- A statement which describes the impact to the company regarding contributions. decisions. recommendations or actions taken by the incumbent. ---- [X] Failure to obtain results or erroneous judgments or recommendations would normally have serious results and may require substantial expenditure of resources to correct and / or achieve goals. ---- Problem Complexity: ---- A statement which describes how clearly a problem is defined when presented. how much additional effort is required to understand the nature of the problem and the typical timescales for resolution. ---- [X] Provides resolution to a diverse range of recognizable complex problems. Analysis is required to identify root cause. Uses judgment within defined boundaries to develop solutions. ---- PHYSICAL DEMANDS AND WORKING CONDITIONS ---- Physical Demands ---- While performing the duties of this job. the associate is required to meet the following physical demands: ---- ---- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ---- Working Conditions ---- While performing the duties of this job. the associate is required to meet the following working conditions: ---- Working Condition None Seldom Occasionally Frequently ---- ---- The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job_ Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.