Quality Improvement Specialist

Quality Improvement Specialist

Requirements

• A current unrestricted RN license
• A High School or GED
• 2+ years of experience in Quality Improvement
• 3+ years of experience in Managed Care
• Experience in compliance and accreditation
• Knowledge of federal and state regulations/requirements

Responsibilities

• Supports the development and implementation of quality improvement interventions and audits
• Monitors and investigates all quality of care concerns
• Collaborates with medical director to determine impact and next steps for actions
• Monitors provider quality complaints to identify trends and educational opportunities for improvement
• Monitors quality improvement initiatives
• Analyzes, updates, and modifies procedures and processes to continually improve QI operations
• Collects and summarizes performance data and identifies opportunities for improvement
• Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met
• Participates in site visit preparation and execution by regulatory and accreditation agencies
• Conducts internal auditing of compliance with regulatory and accreditation standards
• Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics
• Participates in various QI committees and work groups
• Completes follow-up as assigned
• Manages and monitors assigned quality studies
• Investigates and incorporates national best practice interventions
• Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements
• Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline
• Performs other duties as assigned

Preferred Qualifications

• A Bachelor’s Degree in Healthcare, Nursing, Health Administration, Public Health or related health field: Preferred