Quality Program Coordinator
1 week ago
The Quality Program Coordinator is an integral member of the Quality team. This position functions as a self-directed, independent worker under the supervision of the Director of Quality and Compliance. The Quality Program Coordinator provides assistance and support in the development, implementation, and coordination of Health Home initiatives to ensure quality service provision across the network of Care Management Agencies. The position interacts directly with care management agencies (CMAs) and other service providers as well as with Managed Care Organizations (MCOs).
Core Job Competencies:
- CMA Training & Performance Improvement Support: Stay updated with DOH and Skyward policies. Develop and facilitate CMA network trainings for both adult and children's programs. Prepare and share training materials. Assist CMAs with monitoring training attendance. Implement supplemental trainings/office hours to help HHCMs understand their roles and adhere to documentation guidelines, including CMA Performance Improvement Plans.
- Quality Audit Participation: Engage in Skyward's CMA Quality Audit process, including processing audit packages and completing reviews for both adult and children's programs. Collaborate with the Quality Team to create and update tools for targeted reviews, distribute audit materials, and identify documentation/training needs. Participate in Corrective Action planning and assist with stakeholder audit preparation and follow-up.
- CMA Quality Improvement and Assurance: Contribute to Health Home quality improvement and monitoring efforts, including data collection, analysis, and reporting. Recommend and implement procedures to enhance service quality and efficiency. Assist with developing Quality Improvement materials and deploying QI initiatives as needed.
- Compliance Monitoring: Support the Director of Quality and Compliance in addressing compliance violations per state and Skyward policies. Ensure timely submission of required documentation and follow up with Self Disclosure processing to meet OMIG requirements. Facilitate and participate in related investigations and quality improvement initiatives.
- Incident Reporting, Member Grievances, and Fair Hearing Requests: Manage the state IRAMS Incident Reporting system. Submit reports to DOH as required and complete necessary investigations. Interface with enrolled members to resolve grievances, create evidentiary packets for Fair Hearing Requests, and interface with OTDA. Collect and evaluate data on Fair Hearing requests, complaints, and reportable incidents to share during Quality Management Program Committee meetings.
- MCO Data and Information Requests: Participate in care conferences at the request of Plan partners to ensure high-quality services. Work with the Quality Program Assistant to collect necessary documentation, coordinate CMA communications, and follow up on MCO requests/care conferences. Collaborate with the Clinical Quality Manager to address findings and training needs. Manage information and data sharing, including confidential data/PHI, between CMAs and MCOs.
- Performs other related duties, as assigned.
- Bachelor's Degree
- 2-4 years of experience in Health Home and/or Health Home Care Management Agency required
- Preferably, experience in both Adults and Children's Health Home Care Management programs
- Experience working with Foothold Care Management preferred
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:
- Demonstrated commitment to continuing professional development.
- Ability to relate comfortably and professionally with an interdisciplinary care team.
- Ability to work both independently and cooperatively to meet the objectives of the program.
- Acknowledges and complies with Health Information Privacy standards.
- Computer literate and able to utilize an EMR is a must
- Ability to multi-task under pressure
- Ability to work collaboratively and independently on assignments and projects.
- Strong interpersonal skills.
Salary: $62,000/annually
Responsibilities
Relation to Mission
The mission of Sun River Health is to increase access to comprehensive primary and preventive health care and to improve the health status of our community, especially for the underserved and vulnerable.
Equal Employment Opportunity
Sun River Health provides equal employment opportunities to all qualified individuals without regard to race, creed, color, religion, national origin, age, sex, marital status, sexual preference, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function.
Americans with Disabilities Act
Applicants as well as employees who are or become disabled must be able to perform the essential job functions either unaided or with reasonable accommodation. The organization shall determine reasonable accommodation on a case-by-case basis in accordance with applicable law.
Job Responsibilities
The following statements reflect the general duties, responsibilities and competencies considered necessary to perform the essential functions of the job and should not be considered as a detailed description of all the work requirements of the position. Sun River Health may change the specific job duties with or without prior notice based on the needs of the organization.
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