Medical Software Quality Specialist

7 days ago

Washington, Washington, D.C., United States MedStar Health Full time
Job Summary

We are seeking a highly skilled Medical Software Quality Specialist to join our team at MedStar Health. In this role, you will be responsible for assisting with the implementation, integration, and operational direction of the Quality Improvement (QI) program within MedStar Family Choice (MSFC).

Key Responsibilities:

  • Monitor MSFC participating provider processes and outcomes
  • Oversee the preparation and response for the Del Marva and HEDIS audits
  • Act as the liaison between QI and other departments
  • Assist the Medical Director with State reports and meetings
  • Develop department goals, objectives, policies, procedures, quality and safety standards, and performance and productivity standards
  • Ensure compliance with policies and procedures and governmental and accreditation regulations
  • Assist staff members with setting personal and educational goals and objectives
  • Develop and implement education programs to coordinate staff development and training needs
  • Coordinate with the Medical Director and supervise the preparation of the annual audits
  • Provide ongoing individual coaching and support to staff and act as a resource for the QI department
  • Meet regularly with department members to enhance communication and facilitate implementation and progress towards program objectives
  • Maintain current knowledge of benefits, claims, and enrollment issues
  • Prepare and analyze special reports pertaining to all MedStar Family Choice's participating providers
  • Provide first-line response to quality issues and follow the established protocol for reporting any quality issues identified
  • Select, train, orient, and assign department staff
  • Assist with the development of performance standards, evaluate performance, and conduct performance management planning
  • Supervise and provide oversight to delegated entities and report findings to the Quality Improvement Council
  • Evaluate the annual plans, appraisals, quarterly reports, claims, and other issues as they arise
  • Supervise, coordinate, and assist with the collection and interpretation of data on MedStar Family Choice's provider network
  • Access encounter data from vendors to obtain patient information
  • Participate in meetings and on committees and represent the department and hospital in community outreach efforts

Requirements:

  • Bachelor's degree in a healthcare field required or Associate's degree in a related field with relevant experience required
  • Bachelor's degree in Nursing (BSN) preferred
  • 3-4 years Quality improvement experience in an outpatient setting required
  • Valid RN license in the local area serving (State of Maryland or District of Columbia)
  • Certification in a healthcare-related field
  • Proficient with Microsoft Office applications, especially Word, Excel, and PowerPoint
  • Working knowledge of various computer software applications
  • Knowledge of NCQA, HEDIS, InterQual, and local regulatory guidelines preferred

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