QUALITY ANALYST - HOME HEALTH

Independence Health System•Greensburg, PA

16h

About The Position

Data Entering Scrutinize source of data and data received. Remain cognizant of the objective of gathering the data. Gather data in the most efficient and effective manner to streamline processes. Analyzing Data Organize analysis in a manner to effectively and efficiently communicate findings. Communicating Information Prepare analyzed data in a manner so that the reader will understand the purpose for which the information was gathered and conclusions reached. Reporting Prepare and distribute reports on a timely basis, including but not limited to statistical, quality measures. Actively participates in the quality initiative teams; requires active participation on the Home Health and Hospice QaPI Committees Conducts audits for compliance regarding regulatory measures for Home Health & Hospice from payors and other sources. Conducts regular quality audits of patient records, clinical documentation, and care plans to ensure accuracy and adherence to policies. Assists in education to clinical staff with audit findings. Utilizes the current software program to compile data to analyze and develop quality initiatives. Actively participates and/or coordinates actions to improve service or perception of care. Works with different insurance payers and quality programs to maximize reimbursement and improve patient outcomes Work with clinical managers and provide support, education, and/or remediation to the clinical team as needed Ensure compliance with Medicare, Medicaid, and other regulatory requirements and standards Monitor key performance indicators (KPIs) related to patient care, outcomes, and agency performance. Implement performance improvement plans related to key performance indicators. Provide oversight, planning and implementation to new and existing health care quality initiatives and educational programs Responsible for projects related to the Medicare Star Rating Quality of Care Report; delivering impactful initiatives through the design process to completion and measurement of outcomes. Responsible for projects related to the Medicare and other Value based Programs; delivering impactful initiatives through the design process to completion and measurement of outcomes. Leads and manages the agency in planning and executing outcome and claims based strategies and programs Effectively manages internal and external vendor communications by collaborating and disseminating reports, defining program descriptions, and sharing analytical findings. Works with clinical team to mitigate emergency department and hospital utilization as appropriate Works collaboratively with other teams/departments as needed to accomplish quality activities and to ensure that all tasks are accomplished timely and accurately Active participation with affiliated health care related committees as assigned with regular attendance and dissemination of information. Active participation with home health and hospice licensure survey Knowledge and interpretation of home health and hospice Medicare Conditions of Participation Other duties as assigned.

Requirements

Completion of Bachelor’s Degree (Business, Education, or Health Care Related Field)
Graduate of an accredited Nursing Program
2 years of medical/surgical care
2 to 4 years of experience in healthcare with preferred experience in health plan quality improvement, value based care, and/or equivalent experience.
Operational knowledge and expertise with Excel and Microsoft Teams
Strong leadership ability, good organizational skills, independent and critical thinking skills, sound judgment, and knowledge of legal aspects and liability of nursing practice.
Strong ability to communicate complex and/or controversial topics and concepts to a wide and diverse audience.
Current licensure to practice as a Registered Nurse in the State of Pennsylvania required.
Current Basic Life Support (BLS) approved curriculum of the American Heart Association (CPR and AED) program required.
Act 33 with renewal
Act 34 with renewal
Act 73 FBI Clearance

Nice To Haves

Master’s degree in nursing preferred.
Experience with quality tools such as failure mode effects analysis, root cause analysis, SWOT analysis, LEAN or Toyota Production tools.
Home Health experience
CPHQ Certification preferred
Project management and team building experience

Responsibilities

Scrutinize source of data and data received.
Remain cognizant of the objective of gathering the data.
Gather data in the most efficient and effective manner to streamline processes.
Organize analysis in a manner to effectively and efficiently communicate findings.
Prepare analyzed data in a manner so that the reader will understand the purpose for which the information was gathered and conclusions reached.
Prepare and distribute reports on a timely basis, including but not limited to statistical, quality measures.
Actively participates in the quality initiative teams; requires active participation on the Home Health and Hospice QaPI Committees
Conducts audits for compliance regarding regulatory measures for Home Health & Hospice from payors and other sources.
Conducts regular quality audits of patient records, clinical documentation, and care plans to ensure accuracy and adherence to policies.
Assists in education to clinical staff with audit findings.
Utilizes the current software program to compile data to analyze and develop quality initiatives.
Actively participates and/or coordinates actions to improve service or perception of care.
Works with different insurance payers and quality programs to maximize reimbursement and improve patient outcomes
Work with clinical managers and provide support, education, and/or remediation to the clinical team as needed
Ensure compliance with Medicare, Medicaid, and other regulatory requirements and standards
Monitor key performance indicators (KPIs) related to patient care, outcomes, and agency performance.
Implement performance improvement plans related to key performance indicators.
Provide oversight, planning and implementation to new and existing health care quality initiatives and educational programs
Responsible for projects related to the Medicare Star Rating Quality of Care Report; delivering impactful initiatives through the design process to completion and measurement of outcomes.
Responsible for projects related to the Medicare and other Value based Programs; delivering impactful initiatives through the design process to completion and measurement of outcomes.
Leads and manages the agency in planning and executing outcome and claims based strategies and programs
Effectively manages internal and external vendor communications by collaborating and disseminating reports, defining program descriptions, and sharing analytical findings.
Works with clinical team to mitigate emergency department and hospital utilization as appropriate
Works collaboratively with other teams/departments as needed to accomplish quality activities and to ensure that all tasks are accomplished timely and accurately
Active participation with affiliated health care related committees as assigned with regular attendance and dissemination of information.
Active participation with home health and hospice licensure survey
Knowledge and interpretation of home health and hospice Medicare Conditions of Participation
Other duties as assigned.