Quality Improvement Coordinator Clinical

Job Summary

The Quality Improvement Coordinator Clinical is responsible for assisting in maintaining program wide implementation and compliance with local, state and federal regulations.

Essential Job Functions

• Must gather and analyzes participant data and records for determination of admission, treatment, and length of stay in healthcare facility such as hospitals, nursing homes, assisted living, etc. related to clinical review and outcomes
• Must routinely gather and analyze CEC prehospitalization participant care to compare with facility admission information.
• Must track and trend utilization review participant information; as well as outlier criteria to Quality Manager for review with Medical Director and Quality Committee.
• Must abstract data from records and maintain statistics.
• Must analyze the different methods that care is delivered and managed through orders tracking, such as surgical, emergency, postsurgical rehab, respite, etc.
• Must create participant and facility reports when needed to facilitate quality and compliance control.
• Must assist in identifying problems that continue to arise with CEC functionality
• Must keep up to date on applicable laws and regulations related to the CEC program
• Must, when prompted, interview employees to determine their level of knowledge concerning participant care and work flow.
• Must assist in developing new/revised policies and procedures that lead to improved participant care and workflow
• Must assist in compilation of Quality Committee material and meetings.
• Must assist in gathering and documenting of CEC participant/representative grievance and appeals information.
• Must continue to monitor and evaluate the development and results of all improved programs and initiatives to determine their results.
• Must assist in preparing staff and data for CEC's governing agencies reviews and audits.
• Must assist in submission of CEC's governing agencies quarterly and periodic reporting.
• Assist in Quality and Compliance paperwork filing, maintaining a neat and systematic department.
• Assist in design and presentation of curriculums on quality and compliance training needs and topics
• Must compile and interpret statistical data related to quality and compliance
• Must participate in the orientation of new staff related quality and compliance.
• Must enter and maintain accurate data in the Health Plan Management System (HPMS)
• Must maintain data collection of quality data measures set forth by CMS, State of Oklahoma and PACE.
• Must develop quality and compliance date excel, word, slide show, etc. to be presented to staff and vendors.
• Must work with and assist medical/clinical staff and other documenting staff members with participant electronic health records.
• Must be a liaison between Cherokee Elder Care and electronic health record vendors
• Must train and perform electronic health record competency for new employees with electronic health record access
• Requires occasional use of personal vehicle for business purposes.
• All other duties assigned by the Quality Improvement Manager.

Core Job Functions for All Staff

• Attends and participates in staff meetings, inservices, projects and committees as assigned.
• Adheres to and supports the facilities policies, practices and procedures.
• Accepts assigned duties in a cooperative manner and performs all other related duties as assigned.
• Participates on task groups and committees, including the Quality Improvement Program

Working Conditions/Physical Demands

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Working conditions and physical demands include:

• Ability to walk, sit and stand for extended periods of time.
• Ability to access all areas of the facility throughout the work day.
• Ability to hear, talk, taste and smell.
• Vision ability includes; peripheral, color, long distance, close proximity, depth perception and adjusting levels of focus.
• Ability to lift and/or move people/objects over 50 lbs both short and long distances.
• Ability to move about with reasonable accommodation, reach turn, twist and touch.
• Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
• Ability to communicate verbally with an excellent comprehension of the English language.
• Work environment will fluctuate repeatedly throughout the day. Work is performed both indoors and outdoors in varying weather elements and occasionally inside of a vehicle.
• Working conditions can include exposure to odors, fumes, infections, dust, and dirt; which may be objectionable

Knowledge, Skills and Abilities

• Must have strong written, oral and interpersonal skills including professional phone etiquette.
• Must have flexibility with work schedule and a high level of personal integrity.
• Must have working knowledge of physical, psychosocial, behavioral and family needs of the elderly.
• Must have knowledge of community health, social service delivery systems and the aging provider network within the service area.
• Must demonstrate on an ongoing basis the ability to develop and maintain good working relationships with coworkers and department heads while retaining strict confidentiality in all aspects of the position.
• Must have basic computer skills including 10key, typing, scanning and emailing while utilizing Microsoft Excel, Outlook and Word.
• Must have experience utilizing office equipment including phone systems, photocopiers and fax machines.
• Must be detail and accuracy oriented and complete tasks in a timely manner.
• Must be a team player with leadership ability.
• Must attend continuing education courses as needed.

Required Education, Licensure, Experience & Health

Education:

• Must have a Licensed Practical Nursing credential or a higher level degree from a two (2) year college or technical school; or from a four (4) year college or university in Quality Improvement or Nursing field of study

Licensure:

• Current CPR certificate and first aid training.
• Current Driver's License.
• Current Vehicle Insurance in compliance with the Cherokee Nation Motor Vehicle Usage and the CEC Transportation Policy and Procedure.
• A motor vehicle report (MVR) will be completed upon selection and then annually throughout employment. MVR must meet Cherokee Nation Risk Management driver eligibility criteria.

Experience:

• Must have 1 year of experience with a frail or elderly population.
• Must have an accident free driving record with no moving violations within the last 2 years.

Employee Health:

• Must be cleared of all communicable diseases upon hire and subsequently throughout employment
• Must provide proof of immunizations upon hire and subsequently throughout employment

About Cherokee Elder Care

PACE Services: Cherokee Elder Care staff work diligently to fulfill the needs of every participant. The caring and professional team at CEC work hard to provide services with respect, dignity, and integrity to meet participants healthcare needs. Services provided by Cherokee Elder Care PACE include: Primary Care Medical Specialties Occupational, Physical, and Speech Therapy Home Health Services Transportation Social Services Behavioral Health Inpatient, Outpatient, and Ambulance Part D Medication with No Copays Medical Equipment Adult Day Health Center Activities and Socialization

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