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Quality Management Specialist

2 months ago

Camden, United States Upward Health Full time
Job DescriptionJob Description

QUALITY MANAGEMENT SPECIALIST

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health

WHY IS THIS ROLE CRITICAL?

The Quality Management (QM) Specialist supports quality outcomes assessment and performance improvement activities for Upward Health and its clients. Under the supervision of the Director of Quality Management, the QM specialist assists in collecting, collating, and analyzing data for Upward Health’s Quality Performance Improvement program. This position identifies opportunities for improvement, completes root cause analysis, and supports clinical operations to address and close quality gaps between measured performance and outcomes/safety/compliance measures. The QM Specialist assists with implementing performance improvement projects to support new client implementation, on-going monitoring, and overall sustainability for Upward Health’s operations.

The QM Specialist establishes and maintains ongoing relationships based upon company values and supports all clinical staff in a collective effort to serve our patients. The activities, duties, or responsibilities of the QM specialist may change over time to address dynamic client needs in a flexible environment; this job description is not intended to provide an exhaustive list of all activities, duties, or responsibilities but is a characterization of the role and overall expectations from a high level. Upward Health strives to provide patient-centric, value driven care to all our clients and the role of Quality Management specialist is expected to be instrumental to this aim that will grow in scope with expected success and performance.

KEY RESPONSIBILITIES:

  • Promotes mission driven value of high-quality performance with a patient-centric focus that is accountable and consistent.
  • Maintains departmental alignment with enterprise-wide established systems, workflows, and policies.
  • Leverages a data-drive approach to proactively identify and address emerging risk and potential patient safety issues.
  • Provides support to the department to coordinate interdepartmental and intradepartmental meetings, audits, case reviews, application reviews, system record investigations, etc. to further departmental aims.
  • Collaborates with multidisciplinary teams on problem identification and resolution, cost containment issues, implementation of new systems and performance measures.
  • Reviews events requiring further investigation ensuring compliance to program office and regulatory compliance with reporting requirements.
  • Collaborates with leaders to develop and revise policies and procedures to meet regulatory changes and improve quality of care.
  • Extracts, interprets, and analyzes data to complete root cause analysis and data driven decision making.
  • Acts as a liaison and facilitator for quality/patient safety reports related to database tracking, quality trends and analysis, and focused audits as assigned, such as peer review and sharing of learnings.
  • Maintains quality management systems for reporting aggregate data to Quality committee.
  • Develops collaborative relationships with clinical operations to assist with workflow revision and staff to drive quality improvement.
  • Develop surveys/data collection instruments to improve data collection and quality improvement feedback processes and systems.
  • Reviews, analyzes, and interprets relevant regulatory, contractual and compliance information that impacts the company’s quality improvement activities, related programs, and service offerings.
  • Assists the Director of Quality Management to monitor newly enacted legislation, regulations, sub-regulatory guidance (state and federal), and instructions to determine impact on operations and clients.
  • Assists the Director of Quality Management in the development of standard operating procedures and corporate quality improvement policies, written materials to ensure compliance with current state and federal rules and regulations impacting operations and clients.
  • May assist with orientation and onboarding of other new quality assessment and improvement staff, both administrative and professional.
  • Other duties as assigned in support of department goals and objectives.

KNOWLEDGE, SKILLS & ABILITIES:

  • Ability to identify opportunities for improvement to monitor and evaluate the services provided and quality of care based on evidence-based practices.
  • Works with applicable staff to utilize appropriate audit strategies, data extraction, expert observation, surveys, focus groups or other tools to obtain relevant patient experience information to improve care and quality of service.
  • Strong knowledge of Quality concepts, Healthcare, and documentation practices.
  • Remains current with healthcare quality standards and best practices.
  • Excellent written, computer, and oral communication skills.
  • Proficiency in Microsoft Office Suite.
  • Strong organizational and presentation skills.
  • Excellent coordination of multiple schedules and frequently changing priorities from various stakeholders.

QUALIFICATIONS:

  • High degree of proficiency in English language, both written and verbal
  • Bachelor’s degree from an accredited University in a related field in health, life sciences, or business administration
  • Minimum of 3-5 years of direct experience in Quality Management for a healthcare service provider
  • Demonstrated knowledge of healthcare service provision, private insurance providers, public insurance providers (Medicare, Medicaid, CHIP, etc.); familiarity with healthcare terminology and health outcomes including state and federal laws, regulations, and procedures governing the administration of health plans and provision of healthcare services.
  • Strong attention to detail and accuracy
  • Experience preparing, reviewing, and analyzing healthcare data reports
  • Excellent organizational and analytical skills
  • Ability to adapt and learn quickly
  • Ability to prioritize and manage simultaneous projects without supervision
  • Strong sense of ethics and commitment to ensuring quality care in traditional healthcare settings and within community-based, consumer-directed care settings
  • Predominantly operates in an office environment. Some periods of time may be spent in computer room and communications equipment spaces for installation, testing, and troubleshooting.
  • Project Management Professional (PMP) certification a plus
  • Master’s Degree in an area of relevance, for e.g., Healthcare Administration, Health Informatics, Public Health, Public Policy, Social Work, Nursing, preferred
  • 5-10 years of direct experience in Quality Management for a healthcare service provider, preferred
  • Licensed registered nurse (RN), preferred

Upward Health is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce.

This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.