Quality Improvement Coordinator SWHP

JOB SUMMARY
The Quality Improvement Coordinator SWHP works directly with the Manager Quality Improvement SWHP to facilitate the planning, coordination and implementation of quality studies and improvement initiatives. The Coordinator provides overall project support for QI studies and initiatives for the SWHP. This position supports studies and initiatives by gathering data, conducting research, maintaining records, tracking issues, and coordinating activities. The Coordinator works collaboratively across departments to manage the implementation of specific NCQA quality standards and regulatory requirements and writes compliance responses for regulatory agency and accreditation surveys. The Coordinator is required to have extensive familiarity with key elements of the corporate strategic plan, provide conformance to regulatory requirements, contractual obligations and the corporate policies of the SWHP QI program. This position will support liaison(s) and integration of projects with SWHP Clinical teams and SWHP network providers to improve the quality of care and service to SWHP members.
ESSENTIAL FUNCTIONS OF THE ROLE

• Facilitate the design, planning, and implementation of quality improvement studies and initiatives. Design is based on scientific literature, quality publications, and sound quality improvement methodology. SWHP standard work procedures and industry best practices.
• Serve as a primary technical and process resource on all quality related issues. Lead, facilitate, and manage studies and activities in order to improve the overall delivery of health care services for the SWHP. Support appropriate methodologies for collecting, analyzing, validating, managing, and presenting data.
• Manage quality committee, subcommittee and work group meetings, co-facilitate and lead meetings in conjunction with Medical Director or work group chairperson.
• Support clinical studies and HEDIS improvements, abstract clinical data elements from guidelines. Enter findings into applicable database and completes data analysis when indicated.
• Make professional visits to practitioner offices/clinics to conduct medical record reviews and provide information to practitioner office staff and practitioners on HEDIS and other practitioner metrics.
• Write professional quality improvement reports for internal teams, NCQA CMS, and TDI, newsletter articles, and practitioner/office staff educational materials.
• Train new and less experienced QI team members in understanding and effectively utilizing the QI processes and tools, such as facilitation, quality improvement methodology, data analysis and communications.
• Conduct outreach visits to educate/advise practitioners on proper documentation, coding, and billing of medical records according to HEDIS specifications. Publish best practice and Friday Focus articles related to HEDIS specifications and requirements to engage practitioners to actively participate the QI programs/ plans for process improvement as it relates to closing gaps in care and providing a higher quality of care for our members.
• Prepare annual review of department policies and procedures and makes recommendations for updates based of changing needs, trends, and regulatory changes.
• Develop performance improvement targets for quality and efficiency measures, and make recommendations regarding two (2) or more Performance Improvement Plans (PIP) for the QI division, governing bodies (i.e. Texas DHHS), and the health plan per fiscal year. Develop HEDIS Improvement Guide of best practices and billing codes to promote appropriate documentation and coding for HEDIS compliance.
• Perform QI studies as related to trends identified via utilization review activities, utilization patterns, audits, HEDIS results, appeals, etc. Audit patient charts at provider offices via onsite visits or EMR, analyzes trend reports, and preforms other analyses to assist with the documentation of quality improvements.
• Examine medical records and quality related information necessary for QI studies or activities, trend files and other performance data sources to identify new quality issues and areas for improvement.
• Collaborate with Medical Director, Physician Champion, and others to design and implement quality studies.

BENEFITS
Our competitive benefits package includes the following
- Immediate eligibility for health and welfare benefits
- 401(k) savings plan with dollar-for-dollar match up to 5%
- Tuition Reimbursement
- PTO accrual beginning Day 1
Note: Benefits may vary based upon position type and/or level.

QUALIFICATIONS

- EDUCATION - Bachelors or Equivalent Exp

- EXPERIENCE - A minimum of 3 years experience required

• Clinical experience preferred