The Quality Improvement Supervisor is will to work collaboratively throughout the organization to ensure appropriate oversight of the performance management and clinical quality improvement assignments. The Quality Improvement Supervisor is responsible for day-to-day supervision of the work assigned to the clinical staff in the Quality Department.The Supervisor also acts as liaison between the health plan’s physician leadership and community practitioners/providers of care across all specialties and delegates. The Quality Improvement Supervisor is responsible for successful and timely completion of Facility Site Review (FSR), Potential Quality Issues (PQI), Provider Preventable Conditions (PPC), quality of care corrective action plans, clinical performance of HEDIS medical record review.
Principal responsibilities include:
· Supervise the work of the clinical staff in the Quality/Accreditation department.
· Provide clinical guidance to Performance Improvement Projects (PIPs) and Quality Improvement Projects (QIPs) prioritized by the Quality Improvement Program and other strategic initiatives.
· Analyze trends in data from FSR, PQI, PPC and HEDIS medical record review performance.
· Identify programmatic weaknesses and performance gaps in clinical quality metrics.
· Maintain procedures and instructions for self-assessment, performance monitoring and improvement programs as needed.
· Facilitate clinical quality oversight through periodic reviews and reporting of key performance indicators.
· Assist with cause evaluations, effectiveness reviews, and self-assessments related to quality of care projects.
· Assist in resolving complex quality of care problems and facilitate an integrated approach to improvement initiatives
· Developing comprehensive approach to achieve internal and external standards for quality and clinical safety.
· Develops and maintain scorecards for providers with defined expected outcomes & benchmarks based on clinical quality
· Supervise clinical staff in the Quality and Accreditation.
· 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 Performance Improvement 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:
· California licensed Registered Nurse.
· Bachelor’s degree in health related field preferred. BSN is strongly preferred.
MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:
· 4 years of experience in a managed care organization.
· Experience in FSR, PQI, HEDIS or care coordination strongly preferred.
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.
· Knowledge of managed care organization practices, policy, programs, initiatives and functions.
· 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.
· Ability to handle PHI and maintain confidentiality at all levels.
· Proficiency in Windows including Microsoft Office suite including Word, Excel, and PowerPoint.