What are the responsibilities and job description for the Clinical Quality Improvement Specialist position at MetroPlus Health Plan?
Clinical Quality Improvement Specialist
Job Ref : 117464
Category : Quality Assurance
Department : MANAGED LONG TERM CARE
Location : 50 Water Street, 7th Floor, New York, NY 10004
Job Type : Regular
Employment Type : Full-Time
Hire In Rate : $108,000.00
Salary Range : $108,000.00 - $108,815.00
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
About NYC Health Hospitals
MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlus Health network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus Health has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
Empower. Unite. Care.
MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
Under the direct supervision of the MLTC Clinical Quality Manager, the Clinical Quality Improvement Specialist is responsible to review the Uniform Assessment System-NY (UAS-NY) assessments performed by the Assessment Nurses and UAS-NY vendors, ensuring quality and accuracy on documentation and compliance with
Job Description
- Review clinical documentation in order to ensure that all components of the UAS assessment meets quality standards and accuracy following MetroPlusHealth policies and NYS regulations
- Compare UAS and Tasking Tool to ensure correlation
- Upload the UAS to Lenavi and Develop Task Based tool for members
- Assist Assessment Registered Nurses, as needed, to determine areas that require immediate remediation and assist in resolving inconsistencies
- Prepare various reports and correspondences as well as provide summary reports to highlight key findings for implementation of performance improvement plans
- Maintain a tracking tool that will log unacceptable / inconsistent errors observed during quality reviews
- Communicate inconsistences / identified changes to Assessment Nurses and vendors
- Work with management team to identify areas of continuing education for Assessment Nurses and vendors including MetroPlusHealth policies & procedures for UAS and Tasking Tool assessments
- Assess current quality metrics and identify areas for quality improvement including identification of inter-rater reliability scales and examination of intra-rater reliability upon analysis of the UAS-NY data
- Provide feedback to the management team regarding Assessment Nurse documentation
- Prepare technical guides on Assessment Nurse documentation expectations and improvement
- Assist with special projects as assigned to meet departmental goals and policies
- Oversee vendor dashboards for quality initiatives
- Report weekly to management on UAS reviews
- Other duties as assigned
Minimum Qualifications
Licensure and / or Certification Required
Professional Competencies
Salary : $108,000 - $108,815
