Quality Improvement Specialist-Sr
About The Position
Under limited supervision, responsible for performing a variety of clinical support functions for the outpatient setting including patient outreach, care gap analyses, and patient follow up. Performs patient chart reviews to identify opportunities in patient care to satisfy HEDIS measure gaps. Maintains systems for storing and tracking HEDIS medical record documentation. Documents in the Electronic Medical Record. Outreaches and requests charts and medical records from other facilities to close gaps in care. Scans or uploads medical records into payor databases. Performs patient outreach to schedule Annual Wellness Visits and Follow up appointments to fill gaps in care. Performs pre-visit evaluations that identify gaps in care for the clinical team and post-visit evaluations that identify gaps in care after the visit. Educates staff in the clinics about the metrics and how to close HEDIS gaps in care. Identifies, tracks, and follows up on gaps in care that cannot be or were not closed in the clinic. Performs medication adherence reviews to identify and mitigate barriers to patients not taking their medication. Assists in processing hierarchical condition category attestation forms from payors. Identifies opportunities for and works with Senior QISs to implement projects for continuous quality improvement. Using evidence-based principles of change management (e.g. DMAIC and other Quality tools) implements projects and processes to improve workflows, processes, and procedures. Is responsible for creating and publishing workflows for processes for team to follow. Is responsible for organizing and maintaining internal files and folders up to date. Provides in-service training and precepting to Associate Level QI specialists. Creates data visualization for HEDIS metrics and medication adherence. Is responsible for reporting team data at leadership meetings. Meets with payors representatives to identify and discuss strategies for gap closures. Leads quality improvement projects, including root cause analyses, related to quality metrics to focus efforts to positively influence results. Performs all other duties as assigned.
Requirements
- Demonstrates the ability to support the mission, vision and patient promise throughout all interactions, The UT Health Way.
- Demonstrate the ability to communicate effectively, written and verbally.
- Demonstrates analytical thinking – this role requires analyzing information and using logic to coordinate work within schedule constraints and handle emergent requirements in a timely manner
- Demonstrates the ability to participate as an integral part of the interdisciplinary healthcare team in providing the highest quality of care to the patient, The UT Health Way.
- Working knowledge of HEDIS measures for which UT Health is responsible under the shared savings programs
Responsibilities
- Performs patient chart reviews to identify opportunities in patient care to satisfy HEDIS measure gaps.
- Maintains systems for storing and tracking HEDIS medical record documentation
- Documents in the Electronic Medical Record.
- Outreaches and requests charts and medical records from other facilities to close gaps in care
- Scans or uploads medical records into payor databases
- Performs patient outreach to schedule Annual Welllness Visits and Follow up appointments to fill gaps in care
- Performs pre-visit evaluations that identify gaps in care for the clinical team and post-visit evaluations that identify gaps in care after the visit.
- Educates staff in the clinics about the metrics and how to close HEDIS gaps in care.
- Identifies, tracks, and follows up on gaps in care that cannot be or were not closed in the clinic.
- Performs medication adherence reviews to identify and mitigate barriers to patients not taking their medication.
- Assists in processing hierarchical condition category attestation forms from payors.
- Identifies opportunities for and works with Senior QISs to implement projects for continuous quality improvement.
- Using evidence-based principles of change management (e.g. DMAIC and other Quality tools) implements projects and processes to improve workflows, processes, and procedures.
- Is responsible for creating and publishing workflows for processes for team to follow
- Is responsible for organizing and maintaining internal files and folders up to date
- Provides in-service training and precepting to Associate Level QI specialists.
- Creates data visualization for HEDIS metrics and medication adherence
- Is responsible for reporting team data at leadership meetings
- Meets with payors representatives to identify and discuss strategies for gap closures
- Leads quality improvement projects, including root cause analyses, related to quality metrics to focus efforts to positively influence results.
- Performs all other duties as assigned.
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What This Job Offers
Career Level
Senior
Education Level
High school or GED
