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Quality Management Specialist - Clinical

New Horizon Family Health Services
Greenville, SC
  • Posted: over a month ago
  • Full-Time
Job Description

The Quality Management Specialist works under the direct supervision of the Quality Management and Compliance Director. This position provides support to the organization in the areas of Compliance and Quality Management. Areas of focus will include:

Quality Measures: Patient Outcome Data, UDS, HEDIS, meaningful use, and PCMH

Revenue Cycle Management: Coding, Collections, and Billing performance / process improvement.

DUTIES PERFORMED:

  1. Collect and review data related to Clinical Quality Measures to assist the Quality Management and Compliance Director in monitoring patient outcome data. These clinical measures include, but are not limited to UDS, HEDIS, meaningful use, and PCMH requirements.
  2. Assists / conducts reviews as necessary for FTCA, PCMH, UDS, and other internal / external requirements to meet recognition/certification for organization.
  1. Serves as a data miner of EHR / Practice Management / Practice Analytics for Quality Management Department in support of Clinical / Administrative staff for the organization.
  2. Assist Quality Management and Compliance Director in tracking, trending, and reporting of event data within the Event Reporting Process.
  3. Develop classes and other training resources relative to quality improvement needs identified through ongoing monitoring including EHR transition/implementation /training.
  4. Utilize results to support implementation of Process Improvement and conduct PDSAs in areas identified as needing improvement.
  1. Collect and review data related to Practice Support Quality Measures to assist the Quality Management and Compliance Director in monitoring business practice data. These measures include, but are not limited to patient cycle time, third next appointment availability, patient satisfaction data, productivity, and revenue cycle activities.
  2. Prepare and present outcome data to CQI committees on a monthly basis.
  3. Prepare and present outcome data to the New Horizon staff on a quarterly basis. This data is to be presented in an easy to interpret/review manner and is readily accessible to any staff member.
  4. Support the clinical team in quality improvement activities by providing data to track and trend the effects of PDSA implementation.
  5. Assist with the planning, implementation, and evaluation of special programs, as well as the daily activities of such programs as needed. These programs include, but are not limited to, Best Chance Network and Chronic Care Management.
  1. Perform other related duties assigned by the Quality Management and Compliance Director, Chief Medical Officer and/or Chief Executive Officer.
  2. Must hold all patient Protected Health Information (PHI) other patient personal information and agency information in confidence, in accordance with the attached Employee Confidentiality Statement, which I have read, understand and signed.
  3. Actively participate in and comply with all aspects of the NHFHS Corporate Compliance Program, follow the Program Code of Conduct and obey all relevant laws, statutes, regulations and requirements applicable to Medicaid, Medicare and other State and Federal health care programs.

Clinical Quality Specialist Specifications:

  • Collect and review data related to UDS Clinical Quality Measures to assist the Quality Management and Compliance Director in monitoring patient outcome data.
  • Build and support the infrastructure for collaboration with external partnerships for improved clinical outcomes.
  • Planning and organizing internal staff trainings related to UDS Clinical Quality Measures.
  • Collect, track, and trend clinical patient outcomes.
  • Initiate and support quality improvement projects in relation to UDS Clinical Quality Measures.
  • Facilitate communication and collaboration between departments in regards to quality improvement.
  • Provide outreach to patients with identified gaps in care in UDS Clinical Quality Measures.
  • Assist in scheduling and visit planning to close gaps in care and meet UDS Clinical Quality Measures.
  • Document and track efforts to contact and schedule patients to address UDS Clinical Quality Measures.
  • Identify and track high risk patients to ensure completion of UDS Clinical Quality Measures.
  • Proactively identify and address barriers to care.
  • Support patients through offering community resources, providing screenings, and patient education directly related to SDOH and/or barriers to meeting UDS Clinical Quality Measures.
  • Work with the Childhood Health and Immunization Nurse to provide assistance with home visits, immunization clinics, and additional patient assistance related to meeting clinical quality measures as needed.
  • Prepare and present outcome data to CQI committees on a monthly basis.

All New Horizon Family Health Services, Inc. employees are required to be fully vaccinated against COVID 19 as a condition of employment.



Education:

  • Licensed Practical Nurse with SC Licensure and 2 years experience

OR

  • Medical Assistant with 3 years experience in related healthcare employment
    • Direct Patient Care
    • Scheduling and Referrals
    • Care Management

OR

  • A minimum of a Bachelor's degree from an accredited college or university in a related field

Experience:

  • At least two years work experience in a healthcare setting preferred.
  • Experience with data collection, compilation, and analysis preferred.
  • Clinical knowledge and experience preferred.



Benefits:

New Horizon Family Health Services offers a robust and comprehensive benefit package to full time employees. These choices/options include:

Medical, Dental and Vision benefits

Suite of Voluntary Life Insurance, Short Term Disability and Long Term Disability

Flexible Spending and Health Savings Accounts

403 (b) Retirement Plan

Vacation and Sick Leave

Paid Holidays

New Horizon Family Health Services

Address

Greenville, SC
29605 USA

Industry

Healthcare

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