Quality Improvement Specialist
OverviewThe Quality Improvement Specialist conducts, coordinates and monitors quality activities and initiatives for all products of the Health Plan.
Maintains, monitors, and develops strategies for the evaluation of member and/or patient care services.
Analyzes findings and recommends performance improvement initiatives and/or corrective actions.
Identifies performance and process improvement opportunities to improve HEDIS/QARR, Star ratings and Incentive programs.
Assists management with ensuring compliance with regulatory requirements for all products.
Works under general direction.
Responsibilities Develops performance measures, designs data collection instruments, and conducts quality, compliance and utilization reviews.
Ensures Quality Improvement programs are aligned with CMS Triple Aim framework:
improving the patient's experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare.
Collects and analyzes data, identifies trends, writes reports and presents findings to appropriate committees, managers and/or staff.
Prepares, coordinates, and participates in QM Committees and subcommittees as directed.
Participates in the coordination, review and approval of policies and procedures for VNS Health Plans and its delegated entities.
Identifies gaps and recommends creation of new policies.
Qualifications Bachelor's in Healthcare Administration, Public Health, Business or other related healthcare field or the equivalent work experience required.
Master's Degree preferred.
Minimum of three years quality improvement experience in a health plan or health care, setting required.
Ability to work independently, autonomously and self driven.
Excellent oral, written and interpersonal communication skills, including group facilitation skills required.
Knowledge of basic Performance Improvement tools and methodologies preferred.
Medical record collection - supplemental data sources, vendors, EMR remote collecton and occasionally visiting provider and clinical offices to retrieve records Recommended Skills Business Process Improvement Clinical Works Content Management Data Collection Interpersonal Communications Medical Records Estimated Salary: $20 to $28 per hour based on qualifications.
Maintains, monitors, and develops strategies for the evaluation of member and/or patient care services.
Analyzes findings and recommends performance improvement initiatives and/or corrective actions.
Identifies performance and process improvement opportunities to improve HEDIS/QARR, Star ratings and Incentive programs.
Assists management with ensuring compliance with regulatory requirements for all products.
Works under general direction.
Responsibilities Develops performance measures, designs data collection instruments, and conducts quality, compliance and utilization reviews.
Ensures Quality Improvement programs are aligned with CMS Triple Aim framework:
improving the patient's experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of healthcare.
Collects and analyzes data, identifies trends, writes reports and presents findings to appropriate committees, managers and/or staff.
Prepares, coordinates, and participates in QM Committees and subcommittees as directed.
Participates in the coordination, review and approval of policies and procedures for VNS Health Plans and its delegated entities.
Identifies gaps and recommends creation of new policies.
Qualifications Bachelor's in Healthcare Administration, Public Health, Business or other related healthcare field or the equivalent work experience required.
Master's Degree preferred.
Minimum of three years quality improvement experience in a health plan or health care, setting required.
Ability to work independently, autonomously and self driven.
Excellent oral, written and interpersonal communication skills, including group facilitation skills required.
Knowledge of basic Performance Improvement tools and methodologies preferred.
Medical record collection - supplemental data sources, vendors, EMR remote collecton and occasionally visiting provider and clinical offices to retrieve records Recommended Skills Business Process Improvement Clinical Works Content Management Data Collection Interpersonal Communications Medical Records Estimated Salary: $20 to $28 per hour based on qualifications.
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