4 Internal Quality Metrics Specialist Jobs in Corpus Christi, TX
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Internal Quality Metrics Specialist
$86k-103k (estimate)
Full Time
1 Month Ago
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Driscoll Children Hospital is Hiring an Internal Quality Metrics Specialist Near Corpus Christi, TX
Where compassion meets innovation and technology and our employees are family. Thank you for your interest in joining our team! Please review the job information below. General Purpose of Job:The Internal Quality Metrics Specialist is responsible for coordinating quality improvement activities/ projects, metrics measurement and evaluation throughout Driscoll Health Plan (DHP) across all lines of business. Collaborates with other DHP departments to assess, plan, facilitate, implement, monitor and evaluate internal improvement opportunities to enhance compliance with regulatory requirements, accreditation standards and DHP policy/guidelines. Supports the Quality Management team with departmental clinical and non-clinical initiatives including but not limited to: HEDIS®, quality performance metrics, Quality focused initiatives, any/all related Regulatory or committee reports etc.
Essential Duties and Responsibilities:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.
Essential Duties and Responsibilities:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or health plan administration as required.
- Maintains utmost level of confidentiality at all times.
- Adheres to Health System and Health Plan policies and procedures.
- Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
- Demonstrate a high degree of independence, flexibility, initiative, organization, and commitment.
- Coordinates management of key quality metrics and quality/performance improvement projects associated with Accreditation and Regulatory projects and other quality improvement initiatives as indicated.
- In conjunction with QM and DHP leadership, develops and coordinates internal quality review initiatives that assure that both clinical and administrative activities are in compliance.
- Performs internal quality audits and/or case assessments to identify opportunities for improvement
- Develops and implements improvement plans in conjunction with leadership directives and which align with system strategic goals.
- Facilitates development of written quality improvement plans and interventions promoting inter-departmental collaboration for quality/performance improvement projects.
- Identifies data sources, gathers, compiles and evaluates data from various projects/initiatives for reporting to internal leadership and external agencies, (e.g. QM Committee, HHSC Performance Improvement Projects (PIP), Clinical Guidelines, etc.
- Conducts analysis of clinical data, identification of trends/concerns and preparation of recommendations for improvements as indicated in analyzed data in collaboration with the Quality Informaticist.
- Participates in all Quality related reviews, audits, etc. as needed
- Assist in the evaluation of the effectiveness of quality projects/initiatives within DHP in conjunction with the QM Program and work plan.
- Assists with Medical Record audits in conjunction with QM activities as needed.
- Participates in HEDIS® measures audit process including medical record abstraction and determination of compliance with HEDIS® criteria.
- Consults with other departments as needed, to include Credentialing, Utilization Management, Case Management/Disease Management, Claims, Compliance and Provider Relations for all lines of business relative to Quality Improvement Processes as needed.
- Provides training related to quality processes and initiatives for DHP staff and providers as indicated.
- Performs other duties as requested.
- Graduate from an accredited school of nursing required.
- Bachelor's degree (B.S.) from four-year college or university.
- Master's degree preferred.
- A minimum of 5 years’ experience in managed care preferred.
- Experience in quality management/improvement/data science in a healthcare environment preferred.
- Requires experience with computer programs, including Microsoft Office programs (Word, Excel, and PowerPoint).
- Active and Unrestricted Registered Nurse Licensure in the state of Texas.
Job Summary
JOB TYPE
Full Time
SALARY
$86k-103k (estimate)
POST DATE
08/02/2024
EXPIRATION DATE
08/03/2024
WEBSITE
driscollchildrens.org
HEADQUARTERS
Corpus Christi, TX
SIZE
1,000 - 3,000
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