The Quality Improvement (QI) Project Specialist is responsible for providing support for quality assessment and performance improvement activities that include quality monitoring, evaluation and facilitation of performance improvement projects. The QI Project Specialist assists with assessment activities and facilitates compliance with Medicare/Medicaid regulations, state licensure laws, and applicable regulatory/accrediting body. Additionally, the QI Project Specialist participates in company-wide quality initiatives.
· Assist in the design and the execution of quality initiatives.
· Assure the success of healthcare quality improvement projects by performing statistical data analysis and implementing projects in accordance with research design.
· Compile statistical data and write narrative reports summarizing quality assurance and improvement findings.
· Process and manage member and provider communications as appropriate to each project.
· Coordinate and participate in the collection of data from medical records, logs, databases and error reporting systems that support performance improvement and patient safety activities.
· Utilize quality methodology in training departments and multi-disciplinary teams.
· Under direction, conduct concurrent and retrospective focused studies to evaluate and analyze targeted areas of performance.
· Assist in the preparation of quality and safety data reports for committees and meetings.
· Participate in process improvement initiatives, NCQA accreditation activities, and other special initiatives.
· Promote positive inter-department cooperation and participate in applicable committees or task forces. Demonstrate a positive behavior in identifying and resolving complex or out of policy operation problems.
· Comply with all regulatory and licensing agency requirements and promptly inform the applicable person(s) of changes and updates.
· Report and facilitate changes in standards of care as necessary.
· Prepare meeting materials and create meeting quality improvement minutes when warranted
· Perform other duties and special projects as assigned.
ESSENTIAL FUNCTIONS OF THE JOB
· Data collection, measurement, maintenance, and analysis.
· Report and presentation development to support regulatory submissions.
· Coordinate and consult with Alliance departments on QI activities and projects.
· Keep abreast of healthcare industry best practices and managed care regulatory requirements.
· Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
· Constant and close visual work at desk or computer.
· Constant sitting and working at desk.
· Constant data entry using keyboard and/or mouse.
· Frequent use of telephone headset.
· Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
· Frequent lifting of folders and various other objects weighing between 0 and 30 lbs.
· Frequent walking and standing.
· Occasional driving of automobiles.
EDUCATION OR TRAINING EQUIVALENT TO:
· Bachelor’s degree or equivalent in health sciences or related field.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· Two years of relevant project management and QI experience.
SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):
· Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes.
· Strong communication and presentation skills, training/meeting facilitation skills a plus.
· Solid relationship building and interpersonal skills.
· Excellent writing, research, analytical, and time management skills.
· Excellent coordination skills, including multi-tasking and setting priorities on work assignments.
· Ability to organize and coordinate various activities involved in a research, collaborative and demonstration project.
· High degree of independence, flexibility, initiative and commitment.
· Ability to work effectively with diverse population, both internally and externally.
· Solid critical thinking and problem-solving skills.
· Ability to utilize sound judgment and promptly report potential risks.
· Ability to work in a fast paced, patient-service oriented environment.
· Demonstrate ability to promote quality improvement through development and maintenance of standards.
· Must handle PHI and maintain confidentiality at all levels.
· Proficiency in Windows including Microsoft Office suite including Word, Excel, and PowerPoint.