Quality Improvement QI Specialist CBC
Quality Improvement QI Specialist CBC
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Job Description
Job Description
Title: Quality Improvement (QI) Specialist
Department/Division(s): QPM/Quality
Reports To: Compliance Officer & Vice President QPM
Purpose
Under the supervision of the Compliance Officer (CO) & Vice President QPM the QI Specialist supports CBCs enterprisewide quality performance management and improvement platform across CBCs IPA and programs. The QI Specialist contributes to the design of QI measurement strategies and systems provides QI guidance and advising to network partners and provides QI training for CBC staff.
Essential Duties and Responsibilities
Team and Collaborative Tasks
- Works with CO & Vice President QPM to formulate recommendations on opportunities for improvement based on performance measures (inclusive program and contractspecific measures as well as HEDIS/QARR measures related to closing programmatic gaps in care).
Project Management
- Supports the planning implementation monitoring and evaluating of QI initiatives and interventions.
- Research QI methods tools and best practices and develop QI supporting materials.
Quality and Compliance
- Interprets implements and evaluates adequacy of CBC quality improvement standards.
- Supports the QPM team with internal/external audits as needed.
- Collaborates with QPM Specialist and CO & VP QPM on review of QA/compliance issues to identify QI needs.
- Supports QPM Specialist in making recommendations for programs to improve data quality and compliance with CBC program standards.
- Supports network provider agencies with ongoing compliance with quality and regulatory requirements.
- Participates as needed in meetings with Managed Care Organizations and other regulatory entities to analyze performance improvement data and assists QPM Specialist with audits.
- Supports QPM Specialist as needed in review of incidents conducts root cause analysis and reports incidents as directed by regulatory entities.
Reporting and Documentation
- Drafts maintains and edits quality assurance policies and procedures based on contractual guidelines and best practices.
- Interprets implements and evaluates adequacy of quality assurance/ improvement standards.
- Drafts practice standards that are developed through the implementation and evaluation of QI initiatives.
- Works collaboratively with CBCs data team to design review and analyze QI reports and dashboards developed by the data team.
- Reviews and presents QI data in various IPA and program network provider and quality meetings.
- Manages tasks related to extracting aggregating and presenting data for the purpose of measuring performance across network providers.
- Highlights key QI initiatives meetings and statistical outcomes in CBCs newsletter grant applications and other publications as requested.
External Partnerships and Training
- CoChairs the quarterly Network Quality Meeting.
- Develops and facilitates group QI initiatives/activities.
- Works with QPM Specialist to incorporate performance improvement/QI Initiatives (as needed) as part of the Health Home Quality Management Team (QMT) and Childrens QMT meetings.
- Network Provider Agency Training Develops and facilitates trainings in collaboration with CBCs Training Institute to assist network provider agencies for improving processes outcomes and member experience.
- CBC Staff Training Supports Total Quality Management (TQM) across CBC by providing education and training to CBC program staff that are charged with conducting QA/QI activities such as case record reviews incident reporting policy and procedure development internal program reports and PIPs.
- Provides QI coaching and Technical Assistance as needed.
Other
- Performs other related duties as assigned.
Minimum Education and Experience Requirements:
- A bachelors degree in social work Psychology Public Administration Nursing Public Health Public Policy Business or a related field.
- Minimum of 4 years experience with a bachelors degree working with the Behavioral Health population in quality assurance/improvement activities UR/UM.
- Minimum of 2 years experience with a masters degree working with the Behavioral Health population in quality assurance/improvement activities UR/UM.
- Superior communication and writing skills.
- Advanced knowledge of Microsoft office applications including Excel.
- Experience facilitating and/or participating in QI Initiative utilizing Model for Improvement (PDSA) or similar model to measure improvement.
- Experience with Tableau or other data visualization software.
- Experience serving or developing systems who serve persons with chronic health conditions behavioral health conditions persons experiencing homelessness and persons with Medicaid.
- Ability to work with all stakeholders: members network families and government staff in a caring and respectful manner and with due understanding of and consideration for cultural differences.
- Strong customer service skills and the ability to analyze data to resolve provider and insurance service issues.
Additional Details:
- Job Type: Fulltime
- FLSA Code: Exempt
- Salary Scale: $68000 $75000
- Benefits: Comprehensive
- Work Location: Hybrid remote in New York NY 10006
Additional Information DEI Statement
CBCs enterprisewide commitment is to foster a more diverse equitable and inclusive workplace. We are focused on developing engaging and retaining a diverse workforce and leadership team because the more our workforce reflects the diversity of our participants the better and more authentically we serve them and improve enterprise operations.
Our core values of integrity respect maximizing the individual potential maintaining a supportive work environment and being data informed allow us to provide effective timely equitable and peoplecentered services which is the key to positive health outcomes for those we serve.
This job description is not designed to cover or contain a comprehensive listing of activities duties or responsibilities that are required of the employee. Other duties responsibilities and activities may change or be assigned at any time with or without notice.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
