Quality Improvement Specialist

Trinity Health•Mishawaka, IN

7d•Onsite

About The Position

The Quality Improvement Specialist at Select Health Network assists in the continuous quality improvement and organizational excellence of the organization. The Quality Improvement Specialist will have the primary responsibility of coordination assistance directly related to key quality improvement (QI) activities and projects. Activities include but are not limited to data abstraction, generating reports for internal and external purposes, data entry, member outreach to close gaps in care, maintaining member records, chart reviews, and preparation of member mailings to assist in quality measure outcomes. Select Health Network is a Physician Hospital Organization which began operations in 1994 and provides comprehensive physician network in Saint Joseph and Marshall counties, Indiana. In total, Select Health Network offers access to over 1,000 providers, including specialists, primary care physicians, and mid-level providers.

Requirements

Knowledge of a wide range of clinical areas and medical terminology normally acquired by completing a Bachelor’s degree in a clinical area.
Experience in data mining and analysis in a managed care setting.
Knowledge of performance improvement measurement systems and the metrics used to assess performance.
Computer proficient and appropriate telephone etiquette skills required.
Must maintain strict confidentiality of all patient and physician information.
Works with minimal assistance or supervision.
Must be detail oriented with strong organizational and analytic problem-solving skills, as well as have exceptional verbal and written communication skills.
Working knowledge of quality improvement processes and data collection.
Proficient in the use of Microsoft Office Excel, Word, and PowerPoint.
Displays the ability to multitask.
Understands and strives for providing excellent customer service.
Must demonstrate a cooperative demeanor and be comfortable interacting with physicians and physician office staff.

Nice To Haves

Experience in Quality Improvement and/or Case Management is preferred.
One year of managed care experience preferred.

Responsibilities

Actively demonstrates the organization’s mission and core values and conducts oneself at all times in a manner consistent with these values.
Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.
In collaboration with appropriate management and departments, establishes clear objectives, indicators and action plans; then monitors progress and results to assure overall effectiveness and meeting of targets.
Assists with monitoring and reporting for various lines of business.
Effectively interacts with Select departments, health plans and provider practices.
Coordinates with provider offices to gather data and perform chart review as needed.
Collects data from one or more sources including encounters, claims, and other data sources to improve identified quality outcomes and population health goals.
Evaluates reports for accuracy
Responsible for maintaining the integrity of the data by entering information into the appropriate quality documentation system.
Assists in the planning, coordination, and evaluation of QI learning and education sessions related to quality initiatives.
Completes member outreach to close gaps in care.
Maintains quality customer service at all times with patients, exhibiting courteous and professional behavior.
Understands and stays up to date with current HEDIS measures.
Prepares routine reports and other ad-hoc reports utilizing disparate systems
Performs comparisons to external and internal benchmarks to identify opportunities for improvement in quality indicators.
Maintains a working knowledge of each product including, but not limited to, benefit plans, limitations, and additions.
Supports and assists the Quality Improvement Manager in the implementation of QI projects and activities.
Accomplishes workload timely to meet reporting requirements.
Participates in the development of policies and procedures related to quality initiatives and possesses the ability to evaluate current processes for enhancement and make necessary recommendations for improvement.
Provides support for Best Practice implementations at the physician practices
Assists with chart reviews and quality auditing.
Performs other duties consistent with purpose of job as directed and complete special projects as assigned.