Clinical Quality Coordinator

JOB SUMMARY:
Under the supervision of the Director of Quality, identifies patient care needs for/with health care teams (providers and clinical support staff) and assists with care gap data analysis, activities including quality improvement activities and education for DVACO staff, offices and patients.

Collaborates with DVACO partners and colleagues, primary and specialty care providers for all payers to assist with care gap identification and closure, facilitate clinical guideline adherence, payer technical specifications and coordinate services specifically related to patient’s health care needs. Follows and assists with development of guides and other tools for care gap closure, education pathways, guidelines and diagnostic tests to aid the provider care team and patients with office process improvement and assist with the development of work plans.

Maintains documentation and collaborates with all levels of the internal/external health care team/colleagues to develop and improve interventions to maximize clinical, quality, and fiscal outcomes.

Leads and/or participates in the integration of quality improvement activities/projects as required.

Collaborates with other members of the DVACO outreach and health care teams to assure practices adhere to Quality Conditions of Participation and achieve quality metrics allowing for maximizing shared savings/reimbursement from payers.

ESSENTIAL ACCOUNTABIITIES:

  1. Together with Department Director, develop a deep knowledge of DVACO contracts and QI activities that lead to payment by:
    1. identifying populations that require intervention and
    2. cooperatively develop plan to close care gaps identify/implement patient specific
    3. care care/outreach strategies based on EMR information and gaps in care.
  2. Utilizes QI Dashboard for identification of high priority populations and conduct follow-up interactions to assure gap closure.
  3. Works with the Practice Transformation and Care Coordination teams to identify barriers, develop strategies for process improvement, and identify clinically at-risk populations.
  4. Participates with QI team to improve overall Quality strategy and tactics.
  5. Attends and participates in meetings and professional development opportunities to support the work of Quality Improvement/Practice Transformation programs. Develop/ lead and or participate as required with strategic targeted QI activities such as the development of multi-disciplinary work groups and Quality Operations Group
  6. Functions as a SME for all information/software required by payers for supplemental data abstraction and submission process to close gaps in care. These responsibilities include, but are not limited to
    1. the identification and development of internal processes with payer
    2. work with colleagues from Analytics and Operations,
    3. work with colleagues to assure development of comprehensive education, work-flow processes, and tools for all areas of DVACO clinical arena
  7. Responsible to assure that QI Performance Reports and Supplemental Data are distributed and submitted to payers regularly
  8. Functions as a SME for understanding measures, technical specifications required by contract payers and distribute tools to internal/external colleagues
  9. Provide subject matter education to internal and external colleagues/partners and is a resource for issues and questions related to Web Interface abstraction and commercial technical specifications/process
  10. Together with QI Director, develops and implement annual QI Outreach/ intervention work plan
  11. Primary contact with payers for:
    1. Understanding and coordinating resources for improvement initiatives related to all contracted Quality Improvement measures
  12. Collaborate with DVACO Data Analysts for development, reporting, communication, and presentation of ongoing QI data.
    1. Work with Analyst and other DVACO staff to identify various data sources to close gaps in care and/or interventions (e.g. EMR, claims etc.)
  13. Monitor and intervene with MSSP/non-MSSP to improve Quality Improvement results and assure adherence with DVACO Quality Conditions of Participation
  14. Work collaboratively to assure timely, consistent access to all participating provider EMRs
  15. Assists and participates in annual MSSP Web Interface end to end abstraction activities including but not limited to
    1. functioning as a SME for CMS annual quality submission,
    2. assisting with abstraction, education and tool development,
    3. understanding technical specification interpretation, evaluation of program etc.
  16. Participates in outreach activities and data submission projects/QI initiatives as required
  17. Develop and maintain a knowledge base to function as a SME for the Medicare Advantage Star program. Develop overall knowledge of Star measures, technical specifications, and program performance
  18. Create and update DVACO QI Desktops for all functional work performed
  19. Incorporates motivational interviewing, active listening, and demonstrates excellent verbal, written, and problem-solving skills into any needed patient interaction
  20. Maintains patient confidentiality and protects Protected Health Information (PHI) with all activities in Care Gap Management programs.
  21. Performs other duties as required or assigned

Primary Customers or Key Working Relationships:

  1. Work closely with DVACO QI Director, Quality Analyst and other quality/clinical team members
  2. Works as part of an internal/external multidisciplinary team that includes physician and mid-level providers, medical assistants, patient service representatives, coordinators, and administrators.
  3. Works with internal clinical/practice transformation, and oversees work /goals of Outreach Team

SKILLS / COMPETENCIES / QUALIFICATIONS:

Skills and Competencies:

  1. Demonstrates effective communication skills, balance of tenacity and diplomacy with the ability to interact positively and effectively with patients, families and care team members at all levels of the organization.
  2. Demonstrates the ability to work independently and as part of a team including establishing priorities and the capability of handling multiple initiatives simultaneously while meeting strict deadlines/timelines. This includes the ability to be flexible and function effectively in a fluid, dynamic, and rapidly changing environment.
  3. Demonstrates understanding of general physician practice operations. Demonstrates computer skills and proficiency in using multiple electronic health records and other applications, and is familiar with population health in a patient-centered care delivery model.
  4. Possesses well developed management skills with ability to manage both processes, and staff effectively and efficiently
  5. Demonstrates skill in retrieval, manipulation and analysis of data and understanding of computer software using Microsoft products.
  6. Demonstrates a strong customer service attitude.
  7. Demonstrates strong, organizational, and problem solving skills and understanding of clinical processes.

QUALIFICATIONS:

Education: Bachelor degree
Licensures & Certifications: RN preferred. CCDS or CDIP certification preferred

Experience:

  • Minimum of 5 years clinical experience in an acute care setting
  • Previous experience with chart abstraction, knowledge of claims processing/coding a plus
  • Previous management experience, Office Manager Experience preferred.

WORKING CONDITIONS:

Equipment Used:

  1. Computer literate.
  2. Work is typically performed in a corporate office/clinical practice environment with defined hours.
  3. Occasional visits to provider offices may be required

Exposures:

  1. None

We are committed to the health and wellness of our employees. We offer competitive salaries, comprehensive benefits, generous paid time off, 403b savings plan, lucrative pension plan, tuition reimbursement, and more! Learn more about our benefits. If interested, please apply online at https://www.mainlinehealth.org/careers , Job ID 59109

We are an EOE/Veterans/Disabled/LGBTQ employer. Main Line Health celebrates our differences and our similarities. Learn more about our Diversity and Inclusion culture.

Applicants must certify that they have not used tobacco products or nicotine in any form in the 90-days prior to submitting an application to Main Line Health. This will be verified during pre-employment testing. We are an Equal Opportunity Employer. Please, no agency calls