This position will lead Quality Improvement work teams through the development, implementation, dissemination, monitoring, and evaluation of quality initiative projects to improve clinical quality performance metrics including but not limited to those benchmarks established by Health Effectiveness Data and Information Set (HEDIS), Medi-Cal Managed Care Accountability Set (MCAS), National Committee for Quality Assurance (NCQA), and other entities. Assists director/manager in planning, developing, implementing and evaluating projects aimed at optimizing clinical care including clinical guidelines and protocols, clinical process improvement and clinical quality metrics improvement.
POSITION RESPONSIBILITIES:
- Leads QI work teams in areas such as Maternal, Chronic, Pediatric or Adult health. Provides guidance, project management and leadership over work team projects from end to end. Works with collaborating participants intra and interdepartmentally to establish goals, create interventions, implement and evaluate priority projects with input and oversight of medical management.
- Reviews quality and clinical safety performance data against internal and external benchmarks to identify opportunities for quality improvement projects.
- Collaborates with teams to develop and implement rapid cycle improvement projects or Plan-Do-Study-Act (PDSA) projects, performance improvement projects (PIPs), quality improvement projects (QIPs) as required by the California Department of Healthcare Services (DHCS), Center for Medicare and Medicaid Services (CMS) or for other internal quality improvement projects.
- Analyzes and presents results of PIPs and QIPs and reports results to quality teams and senior management.
- Develops specific SMART (Specific, Measurable, Achievable, Relevant, Timebound) aims and metrics, project documents, process flow and other items as applicable.
- Develops run charts, control charts and other graphical representations of CQI project metrics as appropriate.
- Collaborates with teams to develop targeted quality improvement initiatives to improve clinical quality performance measures that include but are not limited to HEDIS, DHCS or CMS metrics, future quality rating system (QRS) metrics, etc.
- Serves as a consultant on improvement projects using quality improvement methodology.
- Participates in education of others on quality improvement methodologies.
- Stays current on regulation changes.
- Other duties and projects as assigned.
Required Skills
- Organize and track numerous and multiple activities, timelines and issues.
- Work independently and as part of a team.
- Evaluate the effectiveness of interventions and programs.
- Communicate clearly and concisely, both verbally and in writing.
- Evaluate the effectiveness of interventions and programs.
- Initiate and follow-through on projects with little supervision or guidance.
- Prepare and present clear and well-organized reports, data, analysis and appropriate findings.
- Utilize and access computer and appropriate software (e.g. Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
Required Experience
EXPERIENCE & EDUCATION:
- Bachelor’s degree required (Public Health or related field preferred); Master’s degree in Public Health or related field preferred.
- 3 years of experience in health care or health plan quality metrics analysis and quality improvement activities/initiatives highly desired.
- 2 years of experience in a healthcare environment required.
- Previous experience in a capitated environment and highly delegated model strongly desired.
KNOWLEDGE OF:
- Industry best practices, including regulatory, evolving member expectations for quality and coordinated care, and the factors that differentiate the organization in the market.
- Continuous quality improvement methodologies and tools including PDSA methodology, fish bone diagrams, control charts, statistical tests for significance, etc.
- HEDIS metrics and other quality performance standards.
- NCQA, CMS, DHCS, preferred.
- Population health analysis.
- Principles of effective analysis and report writing.
- Principles and practices of Medicaid managed health care, health care systems and medical administration.
Grade: L
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