Home-Based Care Quality

2 months ago

Tennessee, United States The Cigna Group Full time
The job profile for this position is Quality Clinical Management Advisor, which is a Band 4 Senior Contributor Career Track Role.

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Job Summary:

The Quality & Patient Safety lead has oversight and responsibility over quality, risk management and patient safety related activities within Home-Based Care. This individual directs the efforts of all the performance improvement initiatives to ensure overall compliance with all regulatory standards including national, state, CMS, NCQA, and other agencies. Works with clinicians and administrators to improve overall patient safety and outcomes. Responsible for the quality, patient safety and risk management programs with an emphasis on patient safety, and harm reduction. Supports, promotes and encourages a culture of safety throughout the business.

Further responsibilities in this role include the facilitation of corrective action, patient assessment, and resolution of family/care giver issues as well as maintenance of open communication with other leaders.

Essential Functions and Responsibilities:

  • Coordinate response to quality and patient safety Senior Leadership Team (SLT) escalations
  • Develop, implement and oversee quality improvement to ensure delivery of the highest quality patient care
  • Develop a conceptual framework for quality measurement and improvement activities across Home-Based Care programs. Summarize findings in the annual Quality Improvement (QI) Plan.
  • Work with the SLT, as well as members of Management, to develop and ensure the implementation of policies to minimize risk within the organization.
  • Coordinate with the Data Analyst and EMR Super User to develop audit systems, perform data analysis and prepare reports related to measuring objectives and tracking outcomes as required by contracts or Home-Based Care business needs.
  • Analyze and report data, as required, in conjunction with the QI Reporting calendar and for recognition through NCQA and accreditation needs.
  • Lead controlled Substance Management and processing violations.
  • Lead NCQA Patient Centered Medical Home recognition and maintenance
  • Work with the CMO and Executive Medical Directors to develop new or update existing clinical outcome measures, protocols, policies and procedures to ensure compliance with policies through a peer review process.
  • Engage in the planning and implementation of the Corporate Compliance Program, including risk management reduction, which includes ensuring compliance with Home-Based Care and Care Delivery policies and procedures as well as health, safety and regulatory requirements including HIPAA, OSHA, and CLIA.
  • Investigate and act, in conjunction with Senior Leadership Team, on matters related to compliance, including coordinate internal investigations and any resulting corrective action with all departments, contracted vendors, etc.
  • Participate in long-range planning including the evaluation of patient satisfaction, current services and programs to increase, and market services to the community and to position Home-Based Care for change and growth.
  • Participate as active member of Quality Review Committee and Clinical Quality Committee

QUALIFICATIONS:

Education:

  • Bachelor's Degree required, preferably a Bachelor of Science in Nursing or healthcare administration
  • Graduate degree in business or healthcare degree preferred
  • CPHQ (Certified Professional in Healthcare Quality), preferred

Experience:

  • Three-five years of leadership and/or five-seven years of quality related experience in healthcare
  • Previous experience in ambulatory care, hospital, or public health required
  • Strong data/analytics background
  • Experience utilizing an electronic medical record required

Knowledge of:

  • Federally Qualified Health Center (FQHC) operations
  • Centers for Medicare & Medicaid Services (CMS) standards and regulations
  • Managed Care Organizations
  • Quality improvement and general quality concepts
  • HRSA regulations and expectations including compliance requirements, Federal Tort Claims Act (FTCA), and 340b pharmaceutical program
  • Preventive and chronic disease measurements and outcomes
  • Nursing assessment, diagnosis, planning, intervention, and evaluation process
  • The healthcare environment as it relates to the patient care delivery system
  • Research databases to remain current on best practices and updates in patient care
  • Available community resources
  • Age-specific care
  • Culturally sensitive care

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.

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