Clinical Quality Improvement Specialist

Position Summary:

The Clinical Quality Improvement Specialist reports to the Director of Quality Operations and is responsible for the implementation and support of initiatives, programs and partnerships within the Quality Department of The Graves Gilbert Clinic. The Clinical Quality Improvement Specialist will collaborate with and support provider offices to ensure the implementation of business strategies and performance metrics are met in assigned value-based care programs and reviewing quality program requirements and workflows to ensure fulfilment of company and business goals and objectives

Position Status- Full time

Days/Hours- 40 hours per week; Monday-Friday; 8:00 am-5:00 pm (unless otherwise indicated)

Primary Responsibilities:                                                                                                                    

• Reflect the mission and vision of Graves Gilbert Clinic in all duties within the Clinic and communities we serve.
• Develop and maintain strong collaboration with providers and practice staff to ensure effective and timely communications of quality improvement strategies.
• Work collaboratively with internal departments and external partners to support the ongoing programs/needs of the department.
• Know, track, and monitor payer-specific incentive program contracts/registries/portals to identify quality gaps and opportunities for outreach to close quality gaps.
• Track and monitor initiatives to improve the quality of care, efficiency and growth in the Clinic across all value-based care programs.
• Leverage and embrace technology to drive process improvement, operational efficiency, and improved clinical results.
• Responsible for implementing and supporting the prioritization, metric development / tracking and ROI associated with new/ongoing projects.
• Track and monitor payer-specific quality and cost metrics and provide routine and ad-hoc reports to the Director of Quality Operations, providers and practice staff.
• Perform targeted quality control and quality assurance reviews of provider and practice staff documentation for assigned quality programs to ensure timely compliance.
• Conduct medical record reviews for accuracy in assigned payer-specific quality and cost measure programs.
• Participate in health plan quality meetings to review clinic progress, identify areas of improvement, and identify operational strategies for improvement.
• Actively participate in team meetings and provide education, feedback, training and coaching to providers and practice staff on current and new operational best practices (e.g. scheduling, use of EHR templates and technology).
• Demonstrates commitment to providing outstanding customer service in a manner that is reflective of The Graves Gilbert Clinic’s mission, values, and customer service standards.
• Travel to assigned practice offices required. Performs other duties as assigned.

Basic Qualifications

• High School diploma or GED required
• RN/LPN preferred

Job Experience required – years and type of specific experience:

• Knowledge of HEDIS, Medicare, Medicare Advantage, ACO, MA Specialty Programs management preferred.
• Experience in ambulatory care, home health, physician practice, utilization management, or other community care setting preferred.
• Three years or more in Healthcare setting

Skills/Attributes:

• Ability to work independently in fast-paced environment.
• Collaborative thinker and ability to function effectively within team-based environments.
• Ability to implement and execute of the Quality Department project plans.
• Demonstrates passion for the business and his/her role; espouses a collaborative approach; leads by example in setting a positive tone.
• Focuses on achieving outcomes while maintaining cultural adherence.
• Cultivates an active network of internal and external relationships and relates well to key colleagues at all levels.
• Respects and appreciates the confidentiality and sensitivity of specific information and situations.
• Energetic about driving results through superb process capabilities.
• Holds oneself to the highest standards of accountability; has the ability to influence change; integrates and aligns efforts across physician practices, monitors results; tackles problems directly.