Quality Improvement Specialist - Clinical |
| Location: | Nashville, TN |
| Exempt/Non-Exempt: | Exempt |
| Employment Type: | Full Time |
| Department: | EQRO |
| Description: | Performs multiple coordination and support functions associated with external quality review activities.. Position will assist in providing team-directed guidance and support to Medicaid health plans and the state regarding various aspects of quality improvement including: development, implementation, measurement, and evaluation.
Performs research and development, coordination, monitoring of various activities, and project management duties related to the hospital engagement network (HEN) contract. Works in collaboration and under the direction of the HEN Coordinator and supports other activities as assigned.
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| Duties: | � Participate in annual compliance reviews including but not limited to: the development of quality assessment tools, scheduling, pre-assessment documentation review, onsite review activities and report preparation.
� Assist in the overall assessment, planning, development, implementation, and evaluation of specific projects and activities as necessary to fulfill HEN contract deliverables.
� Maintain comprehensive knowledge of hospital QI specific projects regarding the HEN contract, pertinent organizations, and health care environment. Knowledge should include information regarding: contract and deliverables, policies and procedures, resources available, current research, and trends.
� Identify, present, and discuss HEN contract progress and issues relating to project and assist in the implementation of solutions.
� Assist in generating reports of HEN project activities, outcomes as assigned or directed.
� Coordinate and participate in organizational and customer meetings.
� Provide technical assistance to the state, Medicaid health plans and HEN hospitals as assigned.
� Coordinates and conducts quality studies including medical record review.
� Willingness to travel approximately 35 percent.
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| Qualifications: | Skills and Abilities
� Strong customer-service orientation, both internally and externally.
� Strong team leadership, quality improvement experience and project management skills.
� Ability to work on multiple projects simultaneously and ability to effectively deal with changes in project requirements.
� Attention to detail including excellent planning and organizational skills.
� Ability to work in a team environment while possessing strong self-directed capabilities.
� Excellent written & verbal communication skills.
� Educational presentations skills.
� Basic computer skills (Word, Excel, PowerPoint, Outlook).
� Takes the initiative to remain current with relevant clinical topics and managed care performance improvement issues.
Education and Experience
� Tennessee licensed Registered Nurse, Masters level or greater preferred.
� Experience in managed care, health care quality improvement, and project management.
� Knowledge and understanding of NCQA Accreditation and HEDIS.
� Knowledge of hospital quality improvement and environment; and clinical areas to include hospital acquired infections, readmissions, and other hospital acquired conditions.
� CPHQ a plus.
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