Quality Improvement Specialist

Job Title

Responsible for providing project support by gathering data, conducting research, maintaining records and tracking issues. Performs and assists 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 provide support for QI studies and initiatives for SWHP.

Salary : The pay range for this position is $18.10 (entry-level qualifications) - $27.15 (highly experienced). The specific rate will depend upon the successful candidates specific qualifications and prior experience.

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 support findings with action plan and conclusions.
• Analyzes 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.
• Facilitate improvement in the overall quality and completeness of medical records documentation by identifying 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 in order to be in full compliance.
• Maintain accurate documentation of all QI activities and prepare reports as required.
• Assure all QI activities are documented, and reported within the organization and externally as appropriate.
• Maintain the confidentiality, integrity and security of all documents in full compliance with SWHP.
• Support the accomplishment of corporate strategic plans that achieve high impact and significant improvements in organizational performance.
• Coordinate and conduct assignments to provide administrative support to QI and clinical analytics teams.
• Contribute to quality improvement activities including but not limited to the following; HEDIS, HOS, CAHPS reporting, 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 reports according to department, documentation standards, and regulatory requirements.
• Assist QI Coordinators in collecting data and preparing reports for the annual program evaluation and QI work plan.
• Perform other position appropriate duties as required in a competent, professional and courteous manner.

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 in order to ensure a productive work environment to achieve goals. Skilled in analytical reasoning, interpreting and evaluating information and have the ability to work in a fast paced, deadlines driven environment.

Benefits

Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note : Benefits may vary based upon position type and / or level.

Qualifications

Education : H.S. Diploma / GED Equivalent Experience : 1 Year of Experience Preferences : CMA, 1-2 years in clinic, EPIC knowledge, scheduling experience As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.