What are the responsibilities and job description for the Director of Assessment Quality Review & Staff Education position at MJHS?
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
Responsible for overall quality and integrity of Plan's assessments conducted by Assessment Nurses and the Independent Assessor (IA).
Monitors reporting to ensure assessments (initial, re-assessment, RFS) follow protocols and DOH policies.
Provides oversight to Quality Review Specialists and Staff Educators.
Develops and oversees quality review planning, including scope, criteria, and measurement of assessments.
Identifies quality indicators from UAS-NY trends and collaborates with Health Economics to capture assessments based on these indicators.
Analyzes data from quality reviews and communicates gap analysis to Staff Development and management.
Ensures accuracy in data correlation between UAS-NY assessments, Tasking Tool, and Paraprofessional Plan of Care (POC).
Oversees updates to the proprietary audit tool EPACT.
Conducts focused reviews based on service utilization trends.
Gathers and analyzes data for the Clinical Assessment Dashboard.
Maintains up-to-date knowledge of regulatory/process changes affecting MLTC/MAP, adjusting reporting specifications accordingly.
Provides gap analysis data to Staff Development and supports updates to Orientation Training Manual.
Ensures timely development and distribution of quality monitoring reports.
Oversees educational Bi-Weekly Newsletters.
Assists in tracking success of Disease Management Programs for CHF, Diabetes, Sepsis, and COPD based on re-hospitalization rates.
Provides feedback to Staff Educators and Field Assessment management to address trends and corrective actions.
Leads Quality Review team meetings to evaluate workflows and review consistency.
Oversees training/re-training of field assessors and ensures staff are well-versed in EP/HF programs.
Maintains up-to-date regulatory knowledge and ensures proper staff education.
Oversees development of competency testing in LMS for Assessment Nurses, Quality Review Specialists, and Clinical Supervisors.
Supports staffing and resource allocation, monitors productivity, and participates in annual budget preparation.
Engages in hiring and selection of qualified staff with Human Resources.
Responsible for overall quality and integrity of Plan's assessments conducted by Assessment Nurses and the Independent Assessor (IA).
Monitors reporting to ensure assessments (initial, re-assessment, RFS) follow protocols and DOH policies.
Provides oversight to Quality Review Specialists and Staff Educators.
Develops and oversees quality review planning, including scope, criteria, and measurement of assessments.
Identifies quality indicators from UAS-NY trends and collaborates with Health Economics to capture assessments based on these indicators.
Analyzes data from quality reviews and communicates gap analysis to Staff Development and management.
Ensures accuracy in data correlation between UAS-NY assessments, Tasking Tool, and Paraprofessional Plan of Care (POC).
Oversees updates to the proprietary audit tool EPACT.
Conducts focused reviews based on service utilization trends.
Gathers and analyzes data for the Clinical Assessment Dashboard.
Maintains up-to-date knowledge of regulatory/process changes affecting MLTC/MAP, adjusting reporting specifications accordingly.
Provides gap analysis data to Staff Development and supports updates to Orientation Training Manual.
Ensures timely development and distribution of quality monitoring reports.
Oversees educational Bi-Weekly Newsletters.
Assists in tracking success of Disease Management Programs for CHF, Diabetes, Sepsis, and COPD based on re-hospitalization rates.
Provides feedback to Staff Educators and Field Assessment management to address trends and corrective actions.
Leads Quality Review team meetings to evaluate workflows and review consistency.
Oversees training/re-training of field assessors and ensures staff are well-versed in EP/HF programs.
Maintains up-to-date regulatory knowledge and ensures proper staff education.
Oversees development of competency testing in LMS for Assessment Nurses, Quality Review Specialists, and Clinical Supervisors.
Supports staffing and resource allocation, monitors productivity, and participates in annual budget preparation.
Engages in hiring and selection of qualified staff with Human Resources.
- Baccalaureate Nursing Degree from an NLN-Accredited School of Nursing.
- Master's degree in nursing, education or related field preferred.
- A minimum of two years Managed Long Term Care and UAS-NY experience required.
- Community Health or related field and/or minimum of two years of progressive job-related experience, including field visits and coordination, education and supervision.
- Demonstrates excellent critical thinking, problem-solving skills, strong interpersonal, organizational skills and knowledge of Medicare and Medicaid.
- Has working knowledge of State and Federal regulations. Works effectively within an interdisciplinary team environment, able to set priorities and to handle multiple assignments.
- Possesses working knowledge of audit techniques and methodologies.
- Able to secure relevant information to identify potential problems and/or trends for staff re-training and implementing corrective action plans.
- Possesses excellent written and verbal communication skills.
- Licensed with current Registration to practice as Registered Professional Nurse in NYS.
- NYS valid driver’s license required for some areas.
