The Quality Services Coordinator coordinates all aspects of the company’s Quality Management Program and quality management initiatives under the direction of the Executive Vice President of Compliance and Quality.
Essential Duties and Responsibilities:
- Provides guidance, coordination and direction for the day-to-day functions of Quality Management services and the Quality Management Program, based on the Strategic Quality Plan.
- Collects, reports, analyzes and trends performance standards for departmental performance reports
- Provides quality oversight of each medical management initiative.
- Oversees and communicates Quality Management and Process Improvement activities throughout CHS internal environment
- Coordinates audit preparation as directed
- Actively coordinates and effectively communicates Quality Management and Process Improvement activities throughout CHS internal environment and external delivery system. Quality Management and Process Improvement activities include but are not limited to:
- Quality improvement monitoring and reporting
- Design and implementation of provider, member and system-level interventions for performance improvement
- Committee structure management and internal and external accountabilities
- Develops and maintains key Quality Management Program documents, including the Strategic Quality Plan, Quality Management Work Plan and Quality Management Program Evaluation.
- Facilitates CHS’s compliance with state, federal and local laws and regulations regarding Quality Management as well as accreditation organization requirements related to all aspects of the delivery system.
- Assists in the development, communication and implementation of the Medical Director’s and CQM Committee’s decisions and/or corrective action plans
- Facilitate, coordinate and direct assigned quality management program(s) to ensure continual compliance with quality program(s) as well as client contracts, accreditation and regulatory standards including but not limited to:
- Monitoring and analysis of monthly, quarterly, and annual QM /UM/CM reporting
- Maintains QM/UM/CM scorecard
- Utilization data evaluation and reporting
- Manages complaint and grievance process tracking and reporting
- Analyzes satisfaction surveys, identifying opportunities for improvement
- Board of Directors dashboard development and maintenance
- Corporate HEDIS program
- Physician Performance Dashboards
- Assists in the development and analysis of statistical data and specifications to determine benchmark standards
- Identifies opportunities to improve clinical care, customer service and internal business processes
- Implements formal quality improvement projects as necessary
- Reviews and analyzes member and provider satisfaction surveys and identifies opportunities for improvement
- Performs quality of care investigations, including preparing cases for Medical Director and Peer Review Committee
- Collects, reports, trends and analyzes elements for departmental reporting
- Collects, reports, trends and analyzes performance standards for departmental performance reports
- Assist in the development, implementation and monitoring of policies and procedures for quality management.
- Establishes and maintain systems for effective communication throughout the care delivery system
- Adheres to the policies and procedures of Community Health Solutions
- Maintains strict confidentiality of client, company and personnel information
- Demonstrates a strong commitment to the mission and values of the organization
- Adheres to company attendance standards
- Performs other duties as assigned
- Strong organizational, analytical, and interpersonal skills
- Ability to present data at staff, peer, management and committee level.
- Detail and process oriented with focus on efficiency
- Language Skills - English fluency
- Business level math, basic statistical analysis
- College level reasoning ability and analytical skills
- Ability to multi-task and work independently
- Supervisory skills as needed
- Project management skills
- Strong organizational and interpersonal skills
- Excellent written and verbal communication skills
- Detail oriented
Education and/or Experience:
- Strong independent and analytical thinking skills are required
- Quality Improvement Project experience
- Committee coordination and presentation experience
- Demonstrated knowledge of utilization management principles
- Demonstrated knowledge of care management principles
- Minimum 2 years’ critical care or 5 years direct patient care experience
Bachelor’s Degree in a health related field required; Registered Nurse licensure required
Certificates, Licenses, Registrations:
- CPHQ preferred
- Certified Case Management (CCM) strongly preferred
Proficiency using word processing, spreadsheet and database software
Environmental Factors/Physical Demands:
Work is performed in an office environment. While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.