Clinical Quality Improvement Coordinator

2 weeks ago

Lexington, Kentucky, United States Catholic Health Initiatives Full time

Position Overview
The Clinical Quality Improvement Coordinator plays a pivotal role in enhancing the quality initiatives within the healthcare network.

Key Responsibilities:
Conduct thorough audits of medical records to ensure compliance with care standards and identify opportunities for improvement.

Utilize various care management and payer systems to accurately document and process claims related to patient interactions and services.

This position collaborates closely with healthcare providers and practice personnel to advocate for best practices in billing, coding, documentation, and overall patient care outcomes.

The Clinical Quality Improvement Coordinator will assess and communicate the quality performance metrics of their designated practices and work in tandem with Ambulatory Care Coordinators to pinpoint challenges affecting quality results.
This role is primarily remote, with some required local travel.

Core Responsibilities:
  • Perform pre and post-visit documentation and claims audits.
  • Ensure clinical documentation aligns with established HEDIS measures and best practices.
  • Review clinical documentation for adherence to the guidelines set forth by the American Medical Association and the Centers for Medicare and Medicaid Services, as well as federal and state regulations.
  • Engage in external audit requests and special projects as necessary.
  • Utilize a variety of systems and interfaces to ensure data accuracy.
  • Optimize reimbursement processes.
  • Communicate effectively with patients and providers in a post-acute care environment.
  • Promote health initiatives.
  • Identify and report barriers to quality outcomes and reimbursement to the Quality Manager.
  • Maintain bi-monthly communication with assigned practices.

This position will focus on key performance indicators and will recommend interventions in areas that are underperforming:

  • Audit and project outcomes
  • Enhance reimbursement processes

Strong collaboration, organizational skills, and attention to detail are essential for success in this role.

Access to sensitive patient information may be required, necessitating a commitment to confidentiality.

Excellent communication skills are crucial, and it is imperative that all written communication is clear and legible.

The responsibilities outlined above are intended to convey the general nature of the work performed in this role and are not exhaustive of all tasks that may be assigned.

Employees may be required to undertake additional duties as needed.


Qualifications
Minimum Requirements:
  • Bachelor of Science in Nursing (BSN) is required.
  • Prior experience in direct patient care, care coordination, disease management, or managed care is essential.
  • Proficiency in navigating electronic medical records and healthcare claims data.
Licensure and Certifications:
  • Current RN licensure in the state of practice is required.
Knowledge, Skills, and Abilities:
  • A minimum of 5 years of clinical, case management, or healthcare experience.
  • Experience working with Medicare and Medicaid populations.
  • Strong communication abilities.
  • Familiarity with information technology.
  • Ability to work independently in a remote environment.
  • Reliable transportation for required travel.
  • Experience in patient education and advocacy.
  • Knowledge of Motivational Interviewing techniques.
Compensation:
Pay range is competitive and commensurate with experience. Catholic Health Initiatives is an equal opportunity/affirmative action employer.

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