PRACTICE QUALITY SPECIALIST
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Lewiston, ME 04243
Under the supervision of the Quality Manager, the Practice Quality Specialist (PQS) supports collaboration, communication, and care coordination with all members of the health care team, including but not limited to HUB leaders, practices, clinicians, and hospital leadership. The PQS is the primary point of contact with and an integral member of the health care team. They will work to ensure safety, best practice and high-quality standards of care across the health care continuum to achieve the quality incentives as part of global payment and managed care contracts with the goal of optimizing our patients’ health and well-being, ensuring that contractual metrics are met, and maximizing financial revenue in our quality risk arrangements. This role is responsible for the communication of targets for medical expense trends and quality outcomes and the facilitation of activities to meet identified targets through analysis of quality, cost, and utilization reports. Assists the health care team in implementing and using systems and interventions to improve patient care and outcomes by identifying key drivers of performance and implementation of project plan(s) initiatives to impact those key drivers.
1. Serves as subject matter expert on CMS/HEDIS ambulatory quality measures and uses that knowledge to effectively communicate information as the central resource to assigned hospital, HUB leaders, physician groups, and clinical teams participating in risk arrangement quality programs.
2. Acts as a key resource to practice(s) for the management of registries of patients that have chronic diseases to ensure they have the required testing and medication management to promote optimal health and clinical outcomes. Ensures pre-visit planning, reminders, and processes on day of visit and subsequent tests and referrals following visits to improve population health.
3. Works collaboratively with practice/providers to develop campaigns to address gaps in care, monitors patient and practice/provider compliance with campaigns, and provide feedback and adjustment as needed to ensure success.
4. Supports process improvements to enhance clinician and staff workflows by identifying potential barriers and making recommendations on improvement initiatives. Audits performance based on recommendations and evaluates compliance and engagement. Effectively communicates key findings to drive informed decision making.
5. Provides expertise, training, and ongoing support for quality measures and the EHRs and related clinical and technical systems that support the collection and tracking of such measures.
6. Performs monthly review of key analytic reports to track overall POD and provider performance by extracting data from the analytic tool(s) and practices’ electronic medical record. Ensures POD, practices, and clinicians are informed on current performance and areas of opportunity for improvement.
7. Provides an effective communication link between POD leaders, practices, and clinicians, and leadership. Escalates issues and/or concerns with practice engagement, participation, or performance to the quality manager and medical director as needed.
8. Identifies and communicates best practice opportunities to POD leaders, practices, clinicians, and team members to help improve performance. Participates in team decisions regarding data requirements for pro-actively managing the team’s panel.
9. Participates as necessary on payer audits for numerator compliance and exclusions on quality measures.
10. Coordinates with the Manager of Quality to track and share data with practice on patient experience improvement measures and performance against goals.
11. Performs other duties as assigned.
1. High school degree or GED required.
2. 3-5 years related work experience required.
3. Bachelor’s degree, Medical Assistant Certification, or minimum 3-5 years related experience in a health care environment. Knowledge of medical terminology.
4. Must be able to travel to offsite meetings at various provider practices and hospitals.
5. Demonstrates, after receipt of training, the ability to use all applicable electronic systems/applications such as Patient Registry, EHR, and population management systems to input, retrieve, and manipulate clinical information, patient registration, and appointment information. Must be highly attentive to detail, accuracy, and achieving end results.
6. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis, and maintain databases.
1. Knowledge of process improvement initiatives such as LEAN or Six Sigma.
2. Knowledge of the Epic electronic medical record.
3. Strong knowledge of and experience with CMS/HEDIS ambulatory quality measures.
1. Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
2. Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge, and skills based on general precedents.
3. Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by the supervisor/manager.
4. Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
5. Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families, and external customers.
6. Knowledge: Ability to demonstrate a full working knowledge of standard concepts, practices, procedures, and policies with the ability to use them in varied situations.
7. Teamwork: Ability to interact respectfully with other employees, professional staff, and/or external contacts to offer ideas, identify issues, obtain information, or deliver services.
8. Customer Service: Ability to provide a high level of customer service to patients, visitors, staff, and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem-solving. Ability to remain calm in stressful situations.