Senior Quality Specialist

Senior Quality Specialist

The Senior Quality Specialist is responsible for implementing the SAMG (Saint Alphonsus Medical Group) Quality and Safety Plan as delegated by the SAMG Director of Quality. The position serves as a mentor and project lead providing guidance to less experienced staff members. Establishes and maintains a partnership with multiple stakeholders within SAMG, including physicians, operations directors, managers, nursing, staff and administration on quality and safety projects. Serves as a consultant to multiple stakeholders in developing solutions to clinical / compliance / standards of care issues and works to accomplish the strategic direction of SAMG and SAHS.

Is actively involved in interfacing with the SAMG infrastructure on system wide collaboratives. Responsible for developing, quantifying and evaluating internal and external quality information and data into actionable intelligence to support the strategic objectives of the organization and to drive operational excellence. The position creates, manages, and reports on information for the network, and provides leadership to foster an approach to continuously improve patient care and quality within the system. Some local travel required.

Bachelor's degree required in Health Information, Public Health, IT, Healthcare Administration or Nursing required. Master's degree strongly preferred. Licensed health care professional preferred. Minimum of three to five years of experience in data analysis, preferably in health care. Experience with HEDIS (Healthcare Effectiveness Data and Information Set), PQRS (Physician Quality Reporting System), and other health care quality metrics required. Experience with payers and quality desired. Must have active driving privileges.

Mentors and trains quality specialists and oversees department projects and workflow. Leads in the development and administration of project work plans and timelines; depending on the complexity of the project, may manage the project budget. Develops and establishes quality improvement measures and testing standards for new applications, products, and / or enhancements to applications.

Gathers and manages data collection and mapping process from numerous sources; may oversee same process with staff : Validates and conducts quality assurance on data collected and oversees preparation of reports. Analyzes patient care and practice patterns within nursing, ancillary and medical staff and identifies issues with opportunities for improvement. Identifies patient safety issues, events, trends and deviations from standard of care.

Assists with creating reports needed for improvement activities. Reviews clinical data from the electronic health record and paper based records, and develops data collection tools for population specific or focused review while maintaining clinical knowledge in practice guidelines and standards. Acts as a resource to all clinics on quality metrics and implementation of corrective actions. Interfaces with practitioners to report, communicate and coordinate quality review data and performance outcomes. Educates clinic staff and providers on performance measures based on quality metrics and regulatory issues.

Maintains knowledge of The Joint Commission (TJC) regulations and requirements, applicable CMS requirements, and payer requirements and has the ability to interpret and give guidance on fulfillment of these requirements. Oversees and monitors medical records forms development and data base. Creates educational tools around regulatory requirements, Performance Improvement (PI) methodologies, and quality and safety goals for the organization, and has the ability to teach others to teach these subjects.

Able to examine performance and identify opportunities for improvement, meets with the teams, facilitates the groups, and takes data to action and results. Supports various councils within SAHS and SAMG as directed, such as the Triad Council, the SAMG Quality Committee, and the Boise Unified Care Organization (UCO) Ministry team. Supports and leads CHE Trinity Health collaboratives that impact SAMG, as directed. Assists in patient care excellence and Culture of Safety surveys as directed by the SAMG Director of Quality.

Health care operations, medical billing and coding, health information technology knowledge required. Ability to read and interpret licensure, accreditation (The Joint Commission) and regulatory (Centers for Medicare and Medicaid) standards.