Quality Improvement Analyst

Quality Improvement Manager

Department : Quality Improvement

Manager Title : Quality Improvement Manager

FLSA Status : Non-Exempt

Job Summary : PCC Community Wellness Center (PCC) is comprised of 15 health centers and serves West Side Chicago and near west suburbs. PCC's mission is to improve health outcomes of the medically underserved communities through a wide range of high quality, affordable, and accessible health services. Quality Improvement (QI) encompasses a broad set of functions within the organization in order to actively improve the overall quality, efficiency, and value of services. The QIA is diligent, well-organized, and detail oriented. Some key duties of the position are collaborating with other departments to create reports, manipulating, and synthesizing data, and monitoring clinical data to meet internal and external requirements. The position is full-time with flexible hours of work. Part-time schedule is available upon review.

Essential Duties and Responsibilities :

• Synthesize, review, and audit pay-for-quality data from insurance carriers, including Aetna, BCBS, Molina, Medical Home Network, Innovista, and Wellcare.
• Analyze pay-for-quality data for inconsistencies via EMR and billing audits, may assist Quality Improvement Manager in summarizing findings and preparing reports as needed.
• Participate in ongoing collaborations with health insurance plans to ensure accuracy and timeliness of data and reports.
• Regularly collaborate with the Care Coordination Department to close gaps in care and maximize outreach efforts. This may include direct patient outreach as needed to support the closure of care gaps.
• Generate patient satisfaction survey reports for all sites and assist in the creation of summaries / infographics using patient satisfaction survey data collected.
• Create and generate Provider Quality Improvement Reports and provide them to Medical Director of Quality Improvement.
• In collaboration with the Quality Improvement Manager, collect and submit documents required for PCMH certification / recognition. Create and validate PCMH reports and conduct PCMH audits.
• Create and run quarterly Peer Review reports.
• Participate in the Reports Committee as needed; may assist with the development of reports for various departments, programs, and grants at PCC.
• Validate UDS quality reports; assist with other UDS data manipulation and analysis as needed.
• Monitor incoming HEDIS requests and submit appropriate documentation when applicable.
• Recommend and implement solutions for existing processes; participate in planning, development, and evaluation of solutions and processes.
• Collaborate closely with staff and external organizations as needed.
• Receive direction and guidance on an ongoing basis from Quality Improvement Manager.
• Perform other duties as required and assigned.

Qualifications

Qualifications :

Physical Demands :

Other Skills :