Job Summary
The Senior Clinical Quality Coordinator is responsible for reviewing processes and improving the daily operations to ensure the highest standards of clinical quality and compliance in the organization. The ideal candidate will analyze organizational processes, identify areas for improvement, and implement quality assurance measures to ensure patient care and operational efficiency. Duties of the role require assessment or investigation, documentation of findings, aggregation of data, preparation of reports for meetings. A senior clinical quality coordinator may be asked to investigate claims against the organization and verify that all activities follow government regulations and institutional policies.
Essential Functions
- Work with the Director of Quality for quality audits for regulatory agencies such as CMS, TJC, etc. and prepares audits of required documents.
- Provides recommendations for quality improvement initiatives including selection of valid and reliable indicators and coordinates monitoring and evaluation activities of selected initiative.
- Analyzes data and prepares detailed, concise, accurate, and meaningful reports in accordance with organization procedures; then defines opportunities for improvement through trend analysis and communicates information appropriately.
- Assist in implementation and monitoring effectiveness of quality initiatives including, but not limited to the development and implementation of preventive health and chronic disease outcomes improvement interventions such as newsletter article, member education and outreach interventions, provider education and outreach interventions, medical record review, focus studies, and surveys.
- Perform monthly, quarterly, annual, and ad hoc medial record reviews including regulatory compliance; Conduct quality of care investigations and using criteria closes case appropriately or refer to Quality Director for further review; prepares cases for Peer Review Committee. Submits respective data to appropriate reporting agencies.
- Provide training and education support to members and providers on standards of care.
- Leading and manage interdisciplinary projects and meetings focused on initiatives to close gaps in care.
Functional/Technical Skills Requirements:
- Comprehensive understanding of operational health care delivery systems and the current health care landscape. Proficient skills and experience with developing competitive business strategies for health care.
- Analytics and Strategy: Expertise in developing and executing data-driven approaches to enhancing business decision-making and improving operational performance (preferably in healthcare). Advanced knowledge of business intelligence best practices, familiarity with fact-based management tools and techniques to drive strategies and a continuous improvement culture.
- Communications: Excellent written and verbal communications skills. Ability to take abstract, complex and/or technical information and effectively convey the message for a variety of audiences at their level of comprehension.
- Cross-functional Team Collaboration: Works independently and resourceful, works effectively in a team environment, provides, and receives constructive feedback from an interdisciplinary team.
- Functional Oversight: Detail oriented and highly organized, proficient in issue identification, gap analysis, ability to prioritize business needs and execute solutions.
- Technology: Proficient in use of health care technology. Skilled in technology-based operational improvement: auditing, data aggregation, monitoring. Proficiency in Microsoft Applications: Word, Excel, PowerPoint, Outlook required.
Minimum Education/Certification:
- Knowledge of local (New Jersey) and national quality management and regulatory standards, including reporting.
- Current unrestricted license in the state of New Jersey required as a Registered Nurse (RN), Physician Assistant (PA), or Advanced Practice Nurse (APN), or completion of Educational Commission for Foreign Medical Graduate (ECFMG) certification.
- For Registered Nurse: BSN degree required, Master's degree in healthcare preferred.
- Medical record review experience required.
Minimum Work Experience:
- Required 2 years’ experience in quality improvement and/or utilization review in an acute care setting.
- Project Coordination / Project Management experience preferred.
PI271642872
