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Quality Management Specialist

New Horizon Family Health Services Greenville, SC

  • Expired: over a month ago. Applications are no longer accepted.
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.


  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.

Internal Procedures and Compliance Specialist

  • Development of and/or modification of procedures, guides and plans.
  • Developing recommendations for program improvements.
  • Identification of training priorities.
  • Developing or obtaining training aids
  • Performing training programs.
  • Auditing for compliance in safety, training, and records of training
  • Auditing for compliance in Credentialing and other required elements related to HRSA compliance
  • Serve as support staff to peer review groups by coordinating meetings, preparing review sheets and finalizing for reporting findings to CMO / respective providers
  • Initiate and support quality improvement projects to ensure continuous quality improvement
  • Assist in the collection and reporting of data for UDS, PCMH, FTCA, etc.
    • Develop and perform scheduled audits to ensure grant and contractual compliance


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


  • Licensed Practical Nurse with SC Licensure


  • HS Diploma and 10 years experience in related healthcare employment:
    • Direct Patient Care and/or Provider Support
    • Quality Management and Compliance Reporting
    • Knowledge of Patient Outcome Measures and Requirements


  • Certification in Medical Coding; AAPC designation preferred


  • Two years work experience in a health care setting preferred.
  • Experience with data collection, compilation and analysis preferred.
  • Experience with EHR and Practice Management Software preferred.
  • Experience with healthcare administration, quality improvement, and/ or healthcare compliance is preferred.

EO Employer M/F/Vets/Disabilities

New Horizon Family Health Services


Greenville, SC
29605 USA



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