Quality Improvement & Utilization Review Coordinator Quality | Full-Time

Blue Mountain Hospital District - John Day, OR

Full-time - Mid Level

John Day, OR

Nursing and Residential Care Facilities

About the position

The Quality Improvement / Utilization Review Coordinator is responsible for developing, implementing, and monitoring the health system's quality and performance improvement programs. This role collaborates with operational leaders to oversee quality activities, manage clinical quality data, and ensure compliance with regulatory requirements. The coordinator will also lead initiatives to enhance healthcare quality and patient satisfaction while acting as a liaison with various stakeholders.

Responsibilities

• Develops, implements, and monitors the Quality Assurance Performance Improvement (QAPI) initiatives for the organization
• Facilitates alignment across the continuum between improvement initiatives and the organization's strategic plan
• Provides leadership and oversight for system-wide data abstraction, aggregating and analyzing data, and reporting of quality metrics
• Develops and maintains the annual system-wide Quality Assurance Performance Improvement program (QAPI)
• Collaborates with Informaticists in the implementation and use of EHR components to maintain compliance with quality initiatives
• Prepares for and leads QI Committee meetings
• Assists with forming and leading a utilization review committee
• Coordinates with third party payers on a regular basis
• Ensures patients receive the Important Message from Medicare and other notifications in the designated time frames
• Works on preauthorizations as needed
• Acts as a patient advocate for financial assistance or other needs
• Learns about Medicare Conditions of Participation
• Responsible for strategic planning related to organizational quality programs and regulatory requirements
• Responsible for the program management of quality incentive programs
• Assesses organization for opportunities for improvement and makes applicable recommendations
• Facilitates organizational adherence to all CMS, DNV, state and other standards and regulatory requirements
• Oversees all reporting and ensures appropriate reporting of quality data
• Analyzes and interprets the regulatory quality and financial data and its impact on the organization
• Identifies and directs performance improvement projects and alignment to assure milestones and key performance indicators are met
• Seeks out areas of industry excellence for benchmarking and research best practices
• Acts as a liaison to all quality programs of payors, state and federal entities
• Assists with the development, administration, and evaluation of patient satisfaction surveys
• Prepares QI reports, dashboards, and provider performance reports
• Provides reports to Senior Leadership, Board of Directors, and other stakeholders regarding quality improvement and assurance
• Develops and implements policies governing the quality program district wide
• Assists with creating or updating utilization review policies as needed
• Provides policy interpretation; evaluates policies and procedures for effectiveness
• Oversight of QI and Utilization review Committee meetings
• Measures and evaluates the effectiveness of the Quality Improvement Program.

Requirements

• Bachelor's or equivalent related experience
• Current certification as Certified Professional in Healthcare Quality (CPHQ) or within two years of hiring date

Nice-to-haves

• Experience in the practice of Six Sigma and LEAN Methodologies
• Current Oregon RN License

Benefits

• Health insurance
• Paid time off
• Retirement plan
• Professional development opportunities