Clinical Quality Specialist

1 day ago

KailuaKona, Hawaii, United States Hawai'i Island Community Health Center Full time
Job Summary

Hawai'i Island Community Health Center is seeking a highly skilled Clinical Quality Specialist to join our team. This role is responsible for reviewing, tracking, and processing quality program-related data, collaborating with patients, providers, payors, and support staff to coordinate patient preventative care services and care gap closures.

Key Responsibilities
  • Collaborate with health insurance plans to promote quality patient care through quality programs such as P4P, ACO, HEDIS, CMS, etc.
  • Collect and deliver supplemental documentation as requested by health insurance plan programs.
  • Collaborate with the care team to conduct patient health maintenance, work with leadership to develop workflows to close payor care gaps, and coordinate appointment scheduling, protocol screenings, health education, and follow-up as appropriate.
  • Assist and participate in quality initiatives and efforts, including support of the Quality Improvement/Quality Assurance Plan, quality incentive programs, and quality campaigns.
  • Promote and support the Patient Centered Medical Home (PCMH) primary care model.
  • Effectively use, interpret, apply, and communicate data and information from multiple sources, assist in the identification, investigation, and resolution of data issues, and carry out activities including data entry, collection, analysis, validation, and reporting.
  • Review quality measures from various measure stewards (UDS, CQM, HEDIS, etc.) for opportunities of performance improvement.
Requirements
  • High School graduate or GED certificate required.
  • 2 years of related experience in healthcare, or any equivalent combination of experience, training, and/or education approved by Human Resources.
  • Associate's Degree (two-year college or technical school) in a related field is preferred.
  • Experience in a Federally Qualified Health Center is preferred.
Preferred Qualifications
  • Proficient in the use of the electronic health record (electronic medical record) to record and retrieve patient health information, obtain reports, and evaluate documentation and associated charges.
  • Knowledge and understanding of data mining.
  • Ability to be flexible and work both independently and in a team environment.
  • Interpersonal relations and customer service skills, facilitating interdepartmental, inter-clinical operations.
  • Good organizational and self-management skills, including time management, document handling and management, etc.
  • Excellent computer skills, including word processing, spreadsheet, and database applications.
  • Understand and proficiently use systems and programs to investigate and resolve data integrity issues, including running and analyzing reports.
  • Demonstrated skill and knowledge of computer systems, including but not limited to word processing, spreadsheet, database, and electronic communication software applications.
  • Ability to pay attention to detail, maintain accurate records, and maintain confidentiality.
Language Skills
  • Ability to read and interpret documents such as government regulations and guidelines, patient records, operating and maintenance instructions, procedure manuals, etc.
  • Ability to write at an above-average level of competence, including internal reports and memoranda.
  • Ability to communicate with diverse groups of people to include staff and providers and patients.
  • Ability to communicate effectively with patients and their families to make their visit a pleasant experience.
  • Sensitivity to the multicultural nature of the service area population and may be required to communicate in another language.

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