Clinical Quality Specialist - Northeast Georgia Physicians Group NGPG - PRN

Northeast Georgia Health System•Gainesville, GA

About The Position

The Clinical Quality Specialist is a key member of the Department of Clinical Quality & Ambulatory Pharmacy Services, and endeavors to ensure that the group is providing the highest levels of quality care and service to our patients. This role is responsible for assessment and measurement of clinical performance, assists in the oversight of non-licensed staff in the department, and for successful compliance with standards/rules/regulations of pay for performance partners. This position interacts with provider, administrative leaders, managers and staff as a resource to achieve desired pay for performance, population health, and performance improvement outcomes. This position also provides support and guidance to improvement and problem-solving initiatives and reporting results to appropriate leaders and organizational committees.

Requirements

Current license as a RN in the State of Georgia required.
Current BLS certification required or must be obtained within 30 days of hire.
Associates Degree.
Graduate of accredited school of nursing supporting RN licensure.
RN: Two (2) years of broad clinical experience required;
Strong interpersonal skills, excellent communication skills, and dedication to providing superior customer service with the ability to express genuine care and concern when dealing with patients/families and other internal customers
Ability to analyze data and patient care processes in a systematic fashion
Keen attention to detail, strong critical thinking and problem-solving skills
Knowledge of personal computers, electronic medical records, and data gathering and review
Ability to work at a rapid pace with numerous interruptions
Demonstrates a high degree of self-motivation; ability to work both independently and as a member of a dynamic team
Ability to work with and maintain highly confidential information

Nice To Haves

CPHQ/CPHRM certification or other quality certification (or willingness to pursue within 12 months of employment).
Bachelors degree highly.
Previous responsibility or experience in quality or performance improvement.

Responsibilities

Performs chart abstractions, chart audits, and documentation reviews to comply with organizational policies and pay for performance initiatives.
Provides education to providers and staff when deficiencies are identified in order to achieve higher compliance scores on quality measures for NGPG goals, payor objectives, and accreditation requirements.
Responsible for reviewing payor HEDIS and pay-for-performance reports; performs chart reviews and audits to identify issues, and collaborates with payors to correct identified issues; builds strong relationships with managed care (payor) representatives.
Investigates variances and potential risk issues related to key pay for performance metrics, performing mini root-cause analysis and/or deep dive investigations where appropriate.
Assists in the orientation, development, and oversight of non-licensed staff (Medical Assistants, Pharmacy Techs) with regard to pay for performance and population health initiatives.
Partners and collaborates with care management staff when necessary and as requested.
Provides training and education to Practice Managers and new providers when requested as part of the on-boarding and orientation process; may provide ongoing training and at the elbow support in meeting metrics as required.
Collaborates in the assessment of population health management technology, to include ongoing optimization, maintaining strong relationship with vendors, training staff and providers on use of technology, and ongoing reporting functions where applicable.
Participates in metric compliance investigations, to include chart reviews, reporting, and interviews with involved staff members and third party payors.
Support, provides and oversees annual abstraction requirements for CMS Medicare pay for performance programs.
Participates as a member of various quality/performance improvement related committees and improvement teams that further pay for performance and population health initiatives.
Collaborates effectively with HP2 and Longstreet staff in order to build robust relationships for the purposes of sharing best practices, creating efficiencies, and optimum patient care outcomes for patients in the clinically integrated network.
Coordinates and acts as a liaison between various NGPG and NGMC departments, physicians, and with meetings, updates, reports, or other planning required in support of clinical integration between the outpatient and inpatient setting.
May serve as Quality liaison for NGPG practices and providers, assisting in the development of performance improvement plans and projects.
Maintains a commitment to professional growth by staying current with requirements of payors and accreditation bodies (NCQA, DNV, etc) as well as quality and LEAN methodologies; is committed to ongoing education and professional development in assigned areas of responsibility.
Advocates for continuous performance improvement and superior customer service throughout the organization.
Other duties as assigned.