QUALITY CARE IMPROVEMENT SPECIALIST
Company: Network Medical Management Inc
Location: Alhambra
Posted on: January 11, 2021
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Job Description:
SUMMARY:The Quality Care Improvement Specialist or QCI
Specialist is responsible in providing department support by
working with our network providers in improving the quality of care
through quality improvement activities that will encompass HEDIS,
CMS Star Rating, and health plan quality performance reporting. The
duties and responsibilities will apply to all IPAs managed by
Network Medical Management.The QCI Specialist is responsible in
supporting the healthcare delivery practice transformation with
providers and staff to support physician practices with redesigning
clinic based care delivery that allow the practice to implement
care on a population based level, improve patient experience and
transition to reimbursement for better healthcare outcomes through
quality care. The role is designed to serve as the key driver in
coordinating the necessary trainings to improve quality measures,
change management, analytics and evidence based clinical processes
under the new standards of care for provider practices.ESSENTIAL
DUTIES AND RESPONSIBILITIES:* Comply with department policy and
procedures* Collect and collate appropriate data from IPA network
providers for HEDIS measures* Advise and coach provider practices
on CMS guidelines for Star Measures (Part C & D)* Collect medical
records, conduct reviews and ensure accuracy of documentation for
reporting* Collect, summarize and trend provider performance data
to include provider education* Participating in ongoing discussions
concerning data collections and analysis for HEDIS* Assist in
planning and implementation of projects to improve delivery of
services and quality of care* Understand the principles of CMS,
HEDIS, NCQA, Health Plan Quality Standards and HIPAA* Provide
in-service training to providers regarding HEDIS and CMS Star
Measures* Attend to provider and interdepartmental calls in
accordance with exceptional customer service* Promote a positive
working relationship between NMM, IPA's and health plan* Establish
trust with and interfaces regularly with project team and leaders*
Support the providers in preparing infrastructure for quality
management implementation through activities such as advising on
team-building, improving communication, facilitating meetings and
helping to develop leadership skills* Communicate the vision for
change through activities such as presenting best practices and
standards of quality of care with preventive care program, HEDIS,
and Star measures* Consult with and enable physicians at each phase
of improvement (i.e., setting goals, thought partnership and
recommending strategies or innovations, and execution) by providing
tools, trainings, guiding them through rapid-cycle tests of change,
and assisting when obstacles arise* Aids practices in customizing
processes to fit their own situation and incorporating the changes
into their day-to-day routines for increased likelihood of
sustainability* Responsible in providing a pleasant and
professional customer service experience to all external and
internal customers* Conduct Provider Training (PCPs& Specialist)
that would include but not limited to:* HEDIS and STAR measures*
Provider Manuals* Web Portal* HIPAA* Attend to health plans,
provider, and interdepartmental calls in accordance with
exceptional customer service; maintain professional and appropriate
behavior (actions/verbal) at all times* Performs other duties,
projects, and actions as assigned.REQUIRED QUALIFICATIONS:*
Bachelor's degree or equivalent experience* 3-5 years of IPA/MSO or
general healthcare experience* At least one year of HEDIS related
experience* Must be able to travel at least 50% of work time*
Working knowledge of managed care and health plan standards*
Excellent analytical critical reasoning and interpersonal
communication skill* Must exhibit efficiency, collaboration,
candor, openness, and results orientation* Ability to understands
and explain data reports in different ways to practitioners*
Experience with and understanding of the outpatient clinical
setting* Excellent presentation, verbal and written communication
skills, and ability to collaborate with co-workers, senior
leadership, and other management.* Proven ability to prioritized
and organize multi-faceted/multiple responsibilities simultaneously
in a fast paced, changing environment while meeting deadlines and
turnaround time requirements* Must be able to work independently
utilizing all resources available while staying within the
boundaries of duties* Must possess the ability to educate and train
provider office staff members* Ability to keep a high level of
confidence and discretion when dealing with sensitive matters
relating to providers, members, business plans, strategies and
other sensitive information is required* Must be ethical and
possess the ability to remain impartial and objective* Proficient
with Microsoft applications* Personal & Professional Qualities*
Punctuality, Creativity, Self-motivation* Professional appearance
and conduct* Conceptual and "big picture" understanding* Able to
function independently under time constraints* Willing to learn and
develop new responsibilities and skills* Good organization,
critical thinking, and problem solving skills* Must be
detail-oriented and able to work autonomously but also as a team
member* Should have strong communication and customer service
skills and respect for confidentialityPREFERRED QUALIFICATIONS: *
Fluent in Spanish or Chinese* Experience in data analytics and
reporting* Knowledge of practice management and/or financial
aspects of the practice
Keywords: Network Medical Management Inc, Alhambra , QUALITY CARE IMPROVEMENT SPECIALIST, Other , Alhambra, California
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