Quality Improvement Spec II
South Bend-IN-46601-United States
Reports to the Director of BMG Quality. The Quality Improvement Specialist will play a critical role in enhancing the performance of value-based purchasing agreements and improving patient outreach efforts to close quality gaps. The specialist will work closely with healthcare providers, administrative staff, and external partners to achieve targeted health outcomes and enhance patient satisfaction. The specialist will conduct direct patient outreach regarding clinically significant gaps in care as needed.
MISSION, VALUES and SERVICE GOALS
- MISSION: We deliver outstanding care, inspire health, and connect with heart.
- VALUES: Trust. Respect. Integrity. Compassion.
- SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.
Value-Based Purchasing Performance:
- The Quality Improvement Specialist will conduct activities to support Beacon Medical Group's favorable performance in ambulatory quality goals and value-based purchasing agreements.
- Collaborate with healthcare providers to ensure adherence to clinical guidelines and best practices.
- Identify and address areas for improvement in patient care and service delivery.
- Analyze patient's chart and submit documentation to ensure quality of care gap and diagnosis/condition closure for the measure year.
- Contribute to strategy development to improve payor performance based on adjustments to contracts year over year.
Data Management and Analysis:
- Collect, analyze, and interpret data related to patient care and service delivery.
- Generate reports for internal and external purposes and develops plans to implement quality improvement strategies.
- Conducts data entry, and member outreach to close gaps in care.
- Maintains EMR accuracy regarding quality measures through chart reviews, member outreach and records requests from various healthcare agencies.
- Coordinates with provider offices, and Health Information Management team to gather documents and ensure proper submission to EMR.
- Collects data from one or more sources including encounters from EMR, claims, and other data sources to improve capture of quality outcomes and population health goals.
- Responsible for maintaining the integrity of the data reported to payor by entering information into the appropriate quality documentation systems and following established quality measure definitions.
- Understands and stays up to date with current HEDIS measure definitions. Conveys important updates to stakeholders as needed.
Patient Outreach:
- Conducts patient outreach as assigned to address gaps in medication adherence and other quality of care gaps.
- Connects patient with community and payor specific resources to ensure gap closure.
- Maintains knowledge of payor specific opportunities in medication refills and screening available.
- Distribute educational materials and conduct communication via the patient's preference to enhance patient engagement.
Miscellaneous:
- Assists in the planning of quality improvement learning and education sessions related to quality initiatives.
- Completing other job-related assignments and special projects as directed.
ORGANIZATIONAL RESPONSIBILITIES
Associate complies with the following organizational requirements:
- Attends and participates in department meetings and is accountable for all information shared.
- Completes mandatory education, annual competencies and department specific education within established timeframes.
- Completes annual employee health requirements within established timeframes.
- Maintains license/certification, registration in good standing throughout fiscal year.
- Direct patient care providers are required to maintain current BCLS (CPR) and other certifications as required by position/department.
- Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
- Adheres to regulatory agency requirements, survey process and compliance.
- Complies with established organization and department policies.
- Available to work overtime in addition to working additional or other shifts and schedules when required.
Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:
- Leverage innovation everywhere.
- Cultivate human talent.
- Embrace performance improvement.
- Build greatness through accountability.
- Use information to improve and advance.
- Communicate clearly and continuously.
Education and Experience
- The knowledge skills and abilities as indicated below are normally acquired through the successful completion of Bachelor's degree.
- RN preferred.
- Previous quality improvement or process improvement experience preferred.
- Candidates with an Associate's degree in a health care field with significant prior experience in one of the two areas. ICD-9-CM and CPT coding experience will also be given consideration. Course work in ICD-9-CM coding system ICD-10 and CPT coding methodology is highly desired.
- Previous quality or process improvement experience preferred.
Knowledge & Skills
- Requires clinical knowledge of medicine, disease, and surgical procedures.
- Requires strong analytical and critical thinking skills necessary to compile, analyze and process clinical information.
- Requires working knowledge of ICD-9-CM, ICD-10 and CPT coding systems and system coding methodologies (for example, to ensure that the correct data is collected and analyzed.)
- Requires knowledge and proficiency in Cerner EMR or ability to learn.
- Demonstrates proficiency in basic computer applications (i.e. email, office word and excel spreadsheets).
- Demonstrates the interpersonal and communication (both verbal and written) skills necessary to effectively communicate and maintain working relationships with physicians and other staff members, ability to develop presentations and lead discussions and the ability to teach others.
- Requires strong organizational skills necessary to effectively establish priorities, meet deadlines, work independently and coordinate multiple tasks.
Working Conditions
- Works remotely or in an office environment.
- Must be effective in a quality-focused environment that frequently deals with important deadlines and schedules.
Physical Demands
- Requires the physical ability and stamina (i.e., reach/pull, bend, stoop, carry lift up to 20 pounds, etc.) to perform the essential functions of the position.
PId5d6d5620f82-37437-38482693
