Quality Initiatives Specialist

Mercyhealth•Janesville, WI

4d•Onsite

About The Position

The MCIC Quality Initiatives Specialist supports initiatives that improve behavioral and medical health outcomes for MercyCare Health Plan members and providers. In this role, you will analyze clinical quality data, identify trends, forecast performance, and present findings to support NCQA standards, HEDIS measures, and applicable state and federal requirements. You will use these insights to plan and carry out quality improvement projects, coordinate member and provider outreach, and facilitate referrals to disease and case management programs.

Requirements

Bachelor's degree from a four-year college or university in related field or at least 5 years of related experience.
Three years of experience in managed care or health care delivery systems.
Experience with EPIC applications (Tapestry and Healthy Planets)
Experience with the following Continuous Quality Improvement methodologies required: Qualitative and quantitative data collection, management, analysis, and reporting.
Management of priorities and deadlines.
Good oral and written communication skills.
Demonstrates persistence and overcomes obstacles.
Proficiency with Microsoft Outlook, Word, Excel, and PowerPoint.
Capable of learning to use information systems and external portals required for performing job functions.
Basic understanding of data warehousing principles and familiar with tools used to extract data.

Nice To Haves

Certified Professional in Health Quality (CPHQ) or Registered Health Information Technician (RHIT) preferred.

Responsibilities

Acts as a lead specialist to provide project, program and /or initiative-related direction and guidance for other specialists within the department and/or collaboratively with other departments.
Assists in monitoring and analyzing outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.
Program and support Microsoft Access databases to manage targeted disease populations and provide efficiencies in work processes.
Design and implement strategies for outcomes improvement based on membership population characteristics and business functions requirements.
Participate in the implementation of Continuous Quality Improvement activities by contributing front line knowledge of projects and observations.
Develop optimal alternative solutions based on feedback and environmental analysis.
Implement process improvement using innovative thinking, root-cause-analysis, process mapping, and charting techniques.
Complete Quality Initiative projects according to specifications and requirements.
Perform the lead role in the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.
Assist Manager in training and takes the lead role in these activities: Abstract data from the medical records and loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
Works with the corporate HEDIS team to monitor accuracy of abstracted records as required by specifications.
Participates in scheduled meetings with the corporate HEDIS team, vendors and HEDIS auditors.
Assists the quality improvement staff with physician and member interventions and incentive efforts as needed through review of medical records documentation.
Provides data collection and report development support for quality improvement studies and performance improvement projects.
Assists in support of accreditation activities such as NCQA reviews, CAHPS and state audits by reviewing clinical documentation.