The Quality Improvement Coordinator will assess, analyze, and recommend quality and clinical performance improvement processes to assure that the highest standards of quality care can be achieved.
Will provide clinical expertise to assist with case-finding, identification of opportunities, and performance improvement activities.
This position will also measure performance and see opportunities to enhance performance in value-based systems of care.
As healthcare evolves with new models of service delivery, quality improvement activities will aim to ensure that care is both patient-centered and focused on maintaining the health of our entire patient population in an efficient and effective way.
This position serves as a key participant in the successful management of value-based contracts, focusing on both individual patients and population trends.
Primary Duties & Responsibilities :
- Identify and prioritize clinical cases in terms of follow up / escalation of services and / or care.
- Perform daily chart abstraction and present patient cases to a multi-disciplinary team with possible care suggestions if applicable and follow through with implementation.
- Engage with care managers, social workers, physicians, external vendors and other stakeholders to ensure continuity of care and follow-through on plan of care.
- Draft correspondence to patients or external vendors on behalf of the care management team or individual physicians.
- Aggregate and clinically analyze quality and value metric data in support of Medical Directors / Chairs of the specific departments as requested.
- Perform in-depth analysis of individual cases as well as trend analysis across the entire population of patients as requested.
- Create clinical quality and value dashboards and action reports in support of performance improvement activities.
- Develop slide decks and other communication tools and make periodic presentations to share trend information with key stakeholders as requested.
- Lead and facilitate daily, weekly and ad hoc meetings discussing patient care.
- Participate in Performance Improvement activities to improve care delivery, clinical outcomes, and clinical efficiency.
- Support HEDIS, pay-for-performance, ACO and other clinical pay-for-performance and pay-for-value program as requested.
- Assist in preparing for and responding to accreditation and regulatory agencies or surveys.
- Performs other duties as assigned.
Education :
Bachelor's Degree in Nursing required. Master's Degree in Nursing preferred.
License & Certifications :
Valid California RN license required.
Experience :
Two (2) years of prior clinical experience in an acute or ambulatory health care setting required. Two (2) years of experience in support of quality improvement, process improvement or total quality measurement preferred
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