ECM Quality Assurance Coordinator

Central Neighborhood Hlth Fdn•San Bernardino, CA

3h•$0 - $27•Onsite

About The Position

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) committed to the Triple Aim as described by the Institute for Healthcare Improvement. Improving the US health care system requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations, and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population. The Quality Assurance Coordinator will work with the Quality & Contracts Supervisor and ECM Director to deliver a comprehensive training program and Quality Assurance program for the ECM program and staff.

Requirements

Bachelor’s Degree or MPH, MBA, MHA, or related Master's degree preferred or relevant experience.
Excellent communication skills, oral & written
Experience in delivering training preferred
Experience with Managed Care/Hospital work experience required
Prior experience performing quality assurance in a healthcare environment
Must have excellent interpersonal skills and empathy towards patients, excellent communication skills, critical thinking skills, the ability to handle stressful situations, the capacity to function independently, have varied clinical experience, and the ability to document meticulously.
Excellent organizational and prioritization skills.
Excellent presentation skills
Ability to manage multiple deadlines in a fast-paced environment.
Strong problem-solving, group facilitation, and teamwork capabilities.
Ability to work with and utilize volunteers in a variety of fundraising capacities.
Active participation in a multi-disciplinary team of professionals and volunteers.
Ability to maintain integrity by keeping proprietary and sensitive information confidential.
Ability to respond with sensitivity to people of diverse cultures and various lifestyles.
Willingness to commit to the philosophy and goals of CNCHC and work as a team.

Responsibilities

Monitor and improve monthly the Quality metrics for all program staff, including but not limited to billing errors, number of encounters, care plan, comprehensive assessment, and authorization compliance.
Track, manage, document, identify, and report patient data.
Assist with monthly reporting, such as creating RTF/OTF, SCR, and CLR.
Ensure member assignment to by health plan to CNHF.
Distribute and monitor the caseload for all LCM staff.
Audit exclusions to ensure all required documentation is on file.
Data entry as needed.
Work closely with LCM and clinical consultants to ensure coordination and transition of care.
Monitor health plan portals for reports and hospital notifications and distribute hospital notifications to staff.
Prepare reports/deliverables for submission to meet Quality requirements, including monthly action plans to LCMs as part of continuous process improvement.
Participating in monthly health plan meetings and training.
Participate in Quality Management team planning meetings as requested.
Utilize a variety of reports to perform QA on all functions within ECM, providing supervisors with the data needed to have constructive feedback sessions with their staff.
Utilize quality assurance activities to identify opportunities for additional training and/or enhancements to the curriculum and develop training materials
Coordinates assigned quality and process improvement activities, which may include process improvement projects, quality studies, CQI (continuous quality improvement) process training for staff, prevention program coordination, and care coordination initiatives.
Conducts quality control reviews and internal audits. Summarizes findings and prepares reports on findings.
Conducts analyses of data findings for quality and process improvement and assists in report preparation for the Quality & Contracts Supervisor and ECM Director.
Supports assigned quality activities through comprehensive project management, ensuring that documentation is accurate and timely.
Review patient healthcare information and records.
Define the level of care for the tier system.
Advise staff and other clinical and non-clinical staff on ECM standards and procedures.
Interacts with nurses, department managers, supervisors, and ECM staff members to provide resource information, resolve ECM-related problems, and identify new opportunities to improve service.
Perform other duties as assigned.