Quality Improvement Specialist

Job Overview

Description

Overview

Medical Associates is hiring a Quality Improvement Specialist to help implement quality improvement initiatives at Medical Associates Clinic and Health Plans!

Daily Activities: Assist with data collection, submission processes, and coordination of clinical quality and patient safety measures consistent with accreditation guidelines and regulatory bodies.  Provide support for service recovery and assist with claims denials processes.

Schedule: Full-time; Monday-Friday between the hours of 8am-5pm; Remote work opportunities available once trained and proficient in position. 

Benefits Package is Worth Over $20,000 and includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc. 

Responsibilities and Essential Functions:

• Complete the submission of Healthcare Effectiveness Data and Information Set (HEDIS) project including but not limited to completing the HEDIS Roadmap, Health Organization Questionnaire, data and rate review, auditing, onsite review, and submission with the assistance of the manager. Request charts, schedule provider/nurse educational meetings and communicate with the various vendors used in the HEDIS process. 
•  Assist with Center for Medicare and Medicaid Services (CMS) star rating and National Committee for Quality Assurance (NCQA) accreditation efforts including program evaluation, work plan, qualitative analysis, education and implementation of initiatives to improve overall quality and standard scores.  Review, update, and develop policies and procedures, administer physician and behavioral health satisfaction surveys, assist with collection of data for reporting related to access, complaints, network adequacy, etc.
• Understand and participate in the Mercy Network Accountable Care Organization (ACO) strategic plan by assisting with reports related to Promoting Interoperability (PI) rates, communicating rates to clinic managers and providers, collaboration with the IT team on workflows and job aids, assisting with PI submission, managing public registry participation, and auditing of Quality measures.  Be the resource to clinic staff on Quality and PI measures through phone, email and meetings (supervisor and departmental).
• Manage the Patient Experience Surveys process which includes but is not limited to: reviewing feedback, identifying service recovery opportunities, contacting patients regarding feedback, documenting patient interaction for provider/manager/director review, assisting Analytics team with reporting to the providers/managers/directors, and providing survey support to patients and clinic staff.  Service recovery communication may include acknowledgement of concerns, assisting with questions or providing non-health related education.
• Complete all other assigned projects and duties.             

Expectations:

1. Develop an understanding of ACO strategies, NCQA standards, and quality improvement to ensure consistent application and process.
2. Maintain confidentiality regarding Medical Associates, its clients and employees.
3. Maintain a friendly, respectful and professional environment for all patient and member contacts.
4. Maintain a cooperative, helpful work environment within the department, as well as, other MAC and MAHP departments, employees, and vendors.
5. Follow Medical Associates Clinic and Health Plan policies, procedures and guidelines.

Knowledge and Skills:

Experience: One to three years of similar or related experience.

Education: Equivalent to a two‑year college degree or completion of a specialized course of study or certification at a business or trade school.

Interpersonal Skills: A significant level of trust and diplomacy is required, in addition to normal courtesy and tact.  Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature.  Work may involve motivating or influencing others.  Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.

Other Skills: Ability to multi‑task, working on multiple cases at one given time.  Good computer and telephone communications skills

Medical Associates Keeps a close eye on the COVID-19 pandemic and all related national, state, and local guidance related to vaccination, masking and the mitigation of disease spread.  

Physical Aspects:

Reaching - Extending hand(s) and arm(s) in any direction.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Vision - 20 / 40 or better in the best eye with or without correction.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities.

Please view Equal Employment Opportunity Posters provided by OFCCP here.