Clinical Quality Improvement Specialist

FLSA Status

Exempt

Job Role Summary

The Clinical Quality Improvement Specialist is responsible for participating in and assisting with the development and implementation of appropriate methods of quality assessment/assurance/improvement and activities as part of the Quality Management Program. This position contributes to external programs and requirements associated with managed care contracts, HRSA and Joint Commission standards, CMS and NCQA programs.  Proactively contributes to Eskenazi Health’s mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County.  Models Eskenazi values of P.R.I.D.E. (Professionalism, Respect, Innovation, Development and Excellence)

Essential Functions and Responsibilities

• Assists in the development, implementation, monitoring and effectiveness analysis of appropriate methods of quality assessment/assurance and quality improvement projects and activities as part of the Quality Management Program
• Interacts with all internal and external customers in a caring and respectful manner in accordance with our Core Values philosophy
• Serves as a subject matter expert for assigned quality measures and has general understanding of all quality measures
• Cofacilitates and supports multiple projects/programs simultaneously including but not limited to outreach, process improvement, external incentive, recognition programs, or contracted programs and adoption of standards of work (SOW)
• Serves as content expert and educates customers on assigned programs (ex: HEDIS, MIPS, PCMH, pay for performance, UDS).  Collaborate with colleagues to ensure successful completion of assigned project(s). 
• Works with direct supervisor to coordinate initiatives aimed at meeting or exceeding clinical performance measure targets 
• Leads internal customers through implementation and management of clinical quality best practices including the process of hard wiring, identifying sustainability opportunities and metrics, identifying opportunities to create new or change existing best practices and ensuring compliance with regulatory and safety standards
• Develop materials and communications to assist with implementation of the quality program including but not limited to cultural and language sensitive patient materials, newsletters, SharePoint page, posters, audit tools, visual aids, presentations, workflows, etc.
• Coordinates and conducts formal presentations and training to various levels in the organization and externally
• Assists in medical record reviews and quality control reviews include participation in the data collection process for HEDIS and other performance measures and on-going audits to ensure data integrity and identify opportunities for improvement
• Supports quality department and internal partners through formal process improvement (PDSAs, LSS, DMAIC, SMART, etc), partners with community and external organizations to reduce barriers to care and collect voice of the customer 
• Cofacilitates committee meetings
• Participates in site visits and audit requests, ensures on-going compliance with regulatory standards (ex: HRSA, FSSA)
• Responsible for development, implementation and adherence to the data governance process and uses data for decision making. Ensures data integrity, policy adherence, proper storage and utilization, and analysis of data to assist with improvement and monitoring of performance.
• Coordinates assigned quality and process improvement efforts which includes, but is not limited to quality studies, auditing, program maintenance, patient experience efforts, regulatory program, care coordination, monitoring and evaluating effectiveness of improvement efforts.

Job Requirements

• Completion of a high school education or equivalent 
• 3 years clinical experience in primary care 
• Completion of Medical Assistant program or Certified/Registered Medical Assistant preferred
• Bachelor’s degree in healthcare or business – preferred 
• 1 year experience with Healthcare Quality Improvement experience 
• Experience with Medicaid Managed Care, HEDIS, CMS, PCMH, and Quality incentive programs preferred
• Valid Indiana Driver’s License
   

Knowledge, Skills & Abilities

• Knowledge of investigative, problem solving, organization, and analytical skills 
• Ability to establish and maintain credibility and build effective relationships 
• Ability to effectively communicate verbally and in writing to various levels of management
• Ability to interpret and present data at staff, peer, management, and committee level
• Knowledge of medical terminology
• Demonstrated competence/knowledge of healthcare field
• Strong PC skills (including Excel, Access, Visio, other reporting database management systems) required
• Ability to work independently
• Able to prioritize and manage multiple tasks/priorities simultaneously
• Knowledge of cross-functional project management 
• Detail-oriented
• Good organizational skills
• Displays good judgment in apprising management of situations that are incompatible with established policies for which there is little precedence