Clinical Quality Specialist Jobs

About The Position

Requirements

• Dental Hygiene Degree or Dental Assistant Diploma and/or applicable military experience.
• At least 3 years of clinical dental experience.
• Ability to investigate, analyze, synthesize, and formulate conclusions.
• Ability to organize quality data in an appropriate reporting format.

Nice To Haves

• Quality experience within a managed care company.
• General knowledge of Medicare, VA, TRICARE, or other government healthcare programs.
• Solid computer skills, with an emphasis on Microsoft Office software.
• Excellent interpersonal, communication, and writing skills.
• Detail-oriented and highly organized, with effective time-management skills.
• Ability to work in a fast-paced, dynamic environment.
• Ability to work in a rapidly changing environment and be adaptable and flexible.

Responsibilities

• Identify and review potential quality issues, patient safety issues, sentinel events, and serious reportable events using best-practice standards of care and clinical experience.
• Conduct timely reviews of electronic medical records in accordance with company standards.
• Research and analyze investigations and prepare written and verbal case summaries with recommendations for further action as appropriate.
• Conduct detailed root cause analyses for sentinel events and serious reportable events.
• Organize and maintain current case investigation information by documenting in quality-of-care and quality-of-service databases.
• Communicate in writing with healthcare providers, track timelines, and perform follow-up as appropriate.
• Develop peer review cases and other quality improvement activities based on deviations from accepted standards of care, and monitor corrective action plans through completion.
• Assist with quality studies and focused reviews by abstracting medical records against specified criteria.
• Participate in quality committees and present cases to peer review quality management committees.
• Collaborate with the Dental Director on complex care identified in potential quality issues, sentinel events, and serious reportable events as needed.
• Read, interpret, and document standards, requirements, and technical specifications.
• Work with stakeholders to review and approve results.
• Actively participate in meetings.
• Train others on relevant policies, rules, and regulations.
• Serve as a resource by providing explanations and expertise.
• Maintain confidentiality of all activities.
• Perform other duties as assigned.

Benefits

• Comprehensive benefits package, subject to eligibility requirements.
• Incentive and recognition programs.
• Equity stock purchase plan.
• 401(k) contribution, subject to eligibility requirements.