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Clinical Quality Specialist
2 months ago
The Clinical Quality Specialist is a key member of the quality department at Northeast Georgia Health System, Inc. This role supports the Quality department by conducting telephonic outreach to patients who require preventative services in support of quality initiatives and regulatory/contractual agreements via three-way phone call, to help close gaps in care. The specialist provides education to patients regarding gaps in care and assists in scheduling appointments. The role acts as a liaison between patients, physicians, healthcare team members, and community resources. The specialist completes special assignments and projects and is instrumental to the function of the department, including abstracting data to compile ACO metric submission. The specialist maintains current knowledge of NGPG practices, physicians, services, and knowledge of current quality measures. The role assists with a variety of quality improvement projects, such as standard work, and works effectively as a team member to ensure best quality care is delivered to patients while maintaining confidentiality of business and protected health information. The specialist refers to care managers or other resources as needed.
Key Responsibilities- Collaborates with and supports team members of the Quality and Risk Services team with key projects and initiatives.
- Performs chart abstractions, chart audits, and documentation reviews to comply with organizational policies and accreditation requirements.
- Provides educational and communications strategies and tools to provider groups and physician practices targeted for recognition; builds and maintains excellent relationships with participating practice contacts in order to advance education and communication goals regarding care gaps.
- Supports team by being the liaison in providing education and communication to project teams, workgroups, task forces, learning sessions, and other meetings as necessary, facilitating meetings, preparing meeting minutes, and ensuring appropriate follow-up of action items regarding clinical quality and care gaps initiatives.
- Reviews and evaluates correspondence from patients, payors, and helps formulate responses and generate documentation as appropriate.
- Assists with educating providers and staff when deficiencies are identified by payors in order to achieve higher compliance scores on quality measures, NGPG goals, payor objectives, and accreditation requirements.
- Generates valid and accurate monthly quality reports from comparison files received from payors and in-house reports collected from provider summary cards, used to find care gaps.
- Participates in meetings with staff, payors, and others to improve strategic use of data and improve quality outcomes and patient care.
- Ensures results/consultation reports are received, reviewed, and added to the electronic health record in an appropriate time frame.
- Manages assigned panel of patients for chart review and identifies opportunities for care follow-up and routing recommendation for providing additional coordination of care, patient outreach, and education to the clinic team in that clinic.
- Licensure or other certifications: LPN, Certification or Registry (CMA/RMA) as a Medical Assistant, Certified Nurse Assistant, or other comparable clinical experience (e.g., EMT-P, Medical Scribe, or related).
- Educational Requirements: High School Diploma or GED.
- Minimum Experience: Five (5) years experience in healthcare, with at least three (3) years in direct patient care in a clinical environment.
- Other:
- Preferred Licensure or other certifications:
- Preferred Educational Requirements: Bachelors degree, in health/human services.
- Preferred Experience:
- Other:
- Weight Lifted: Up to 50 lbs, Occasionally 0-30% of time.
- Weight Carried: Up to 50 lbs, Occasionally 0-30% of time.
- Vision: Moderate, Frequently 31-65% of time.
- Kneeling/Stooping/Bending: Occasionally 0-30%.
- Standing/Walking: Occasionally 0-30%.
- Pushing/Pulling: Occasionally 0-30%.
- Intensity of Work: Frequently 31-65%.
- Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving.
