Hiring for Quality Improvement Specialist – SWHP at Remote Full Time

JOB SUMMARY

Accountable for providing project help by gathering data, conducting research, maintaining records and tracking issues. Performs and helps in studies and initiatives related to HEDIS/Medical Data Collections, Scott and White Health Plan (SWHP) QI studies and initiatives. Works directly with the SWHP Quality Improvement Manager and QUI Coordinators to plan, organize and give help for QI studies and initiaives for SWHP.

ESSENTIAL FUNCTIONS OF THE ROLE

• Monitor and evaluate data to identify areas of quality and performance improvements.
• Performs data collection using various sources, including retrospective review of medical records, focusing on reliability of resulting data.
• Medical record abstraction for NCQA HEDIS medical record review project (January-May).
• Clearly document information to help findings with action plan and conclusions.
• Examines data by doing appropriate drilldowns into the data and using various continuous quality improvement tools, focusing on identifying explanations for variation and opportunities for improvements.
• Help improvement in the overall quality and completeness of medical records documentation by indentifying educational opportunities to address deficiencies.
• Gather data and prepare documents to submit to regulatory agencies to ensure compliance.
• Prepare and maintain documents for NCQA, TDI, CMS and HHSC surveys to be in full compliance.
• Maintain accurate documentation of all QI activities and prepare s as required.
• Assure all QI activities are documented, and ed within the organization and externally as appropriate.
• Maintain the confidentiality, integrity and security of all documents in full compliance with SWHP.
• Help the accomplishment of corporate strategic plans that achieve high impact and significant improvements in organizational performance.
• Coordinate and conduct assignments to give administrative help to QI and clinical analytics teams.
• Contribute to quality improvement activities including but not limited to the following; HEDIS, HOS, CAHPS ing, customer satisfaction survey results, peer review, health promotions, quality of care and quality of service monitoring, coordination with regulatory agencies, focused quality improvement studies, clinical protocol and guideline updates.
• Accurate recording of meeting minutes and other documentation essential for the overall completion of the QI projects.
• Prepare and distribute accurate and timely s according to department, documentation standards, and regulatory requirements.
• Help QI Coordinators in collecting data and preparing s for the annual program evaluation and QI work plan.
• Perform other position appropriate duties as required in a competent, professional and courteous way.

KEY SUCCESS FACTORS

• Associates degree (two-year program) or equivalent formal training program in a health related field preferred.
• Quality Improvement/Assurance, Healthcare or other Managed Care related field is preferred.
• Proficient in Microsoft Office Suite, including but not limited to, Outlook, Word, Excel, Access and Power Point.
• Excellent written and verbal communication skills, as well as attention to details and deadlines.
• Demonstrates problem solving, leadership, conflict management and team building skills to ensure a productive work environment to achieve goals.
• Skilled in data reasoning, interpreting and evaluating information and have the ability to work in a fast paced, deadlines motivated environment.

BENEFITS

Our competitive benefits package includes the following

• Immediate eligibility for health and welfare benefit
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based on position type and/or level

QUALIFICATIONS

• EDUCATION – H.S. Diploma/GED Equivalent
• EXPERIENCE – 1 Year of Experience