Quality Improvement Clinical Specialist

$79,040 - $110,240/Yr

Nc Dhhs - Raleigh, NC

Full-time - Mid Level

Remote - Raleigh, NC

10,001+ employees

Nursing and Residential Care Facilities

About the position

The Quality Improvement Clinical Specialist at the North Carolina Department of Health and Human Services (NC DHHS) plays a crucial role in enhancing the quality of health services provided to Medicaid recipients. This position involves analyzing data from quality initiatives, coordinating with stakeholders, and leading quality improvement activities to ensure compliance with established standards. The specialist will work collaboratively to identify opportunities for improvement and support various projects aimed at enhancing health outcomes for vulnerable populations in North Carolina.

Responsibilities

• Assist with analyzing and interpreting data from quality initiatives and critical incidents to foster improvement of services to Medicaid recipients.
• Ensure QPHE processes meet established standards and have quality improvement standards to improve quality by changing systems.
• Coordinate with key stakeholder teams inside and outside of DHB for enhancement of QI activities.
• Identify opportunities for improvement based on analysis of data provided by Health Plans, the State, and other National Data sources.
• Provide feedback to leadership on initiatives, KPIs, or potential cross-collaborative opportunities to inform on strategic planning.
• Participate in reviews of Performance Improvement Projects, Quality Assessment and Performance Improvement Plans, and Quality Management and Improvement Programs.
• Expected to lead 2-3 Quality Improvement activities per 12-month contract.
• Participate and support other projects for QPHE.

Requirements

• 2-3 years of Quality Improvement experience.
• Previous experience with HEDIS Measures.
• Clinical Professional (Nurse or LCSW with hospitalist experience).
• Advanced credit given for CPHQ or PMP or Six Sigma Yellow Belt certification.
• Proficiency in Microsoft Office suite (Word, Excel, PowerPoint, Outlook).
• Experience establishing and maintaining collaborative relationships with internal and external stakeholders.
• Demonstrated ability to apply analytical and problem-solving skills in a proactive manner.

Nice-to-haves

• Preferred experience with Managed Care, Medicaid, Medicare, or Accountable Care Organizations.
• Preferred experience with understanding of Population Health interventions and outcomes.
• Functional and applied knowledge of Center for Medicare/Medicaid Services (CMS) rules, policies, and regulations.
• Functional and applied knowledge of Medicaid and Medicaid Transformation.

Benefits

• Flexible schedule
• Opportunity to enroll in an ACA plan through NC State University for temporary employees working at least 30 hours per week for 3 months or more.
• Hybrid working arrangement with in-person work on Dix Campus in Raleigh, North Carolina.