Clinical Quality Improvement Specialist
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The Clinical Quality Improvement Coordinator will assist with the plan, design, and maintenance of a comprehensive continuous quality improvement (CQI) program including utilization management and risk management. Function as a health plan liaison for quality and value-based care. Assists in educating new staff, including physicians, about QI systems and requirements.
- Meets with internal and external audiences to identify and problem solve QI issues.
- Monitors patient records in effort to ensure compliance with internal and external QI standards. Reviews medical records and other documentation to ensure quality care. Helps to prepare monthly and annual QI report.
- Coordinates the effort to gather data and prepare reports to meet the requirements of UDS and other regulatory/accrediting agencies, including patient satisfaction data.
- Evaluates variance and other data to identify QI opportunities and risk management issues.
- Monitors utilization and service quality through diagnosis-related group (DRG) review, HEDIS quality measures, payer/provider/patient satisfaction surveys, and complaints. Reports on results.
Duties and Responsibilities:
- Works with leadership on peer review activities.
- Coordinates the development, implementation, and revision of the QI program to meet the needs of patients, staff, and external agencies.
- Organizes, compiles, and reports QI data for the clinical department to identify trends, establish priorities, and recommend improvement activities.
- Performs comprehensive, concurrent, and retrospective reviews in a timely manner, using criteria developed and approved by the medical staff and the hospital.
- Works alongside other QI team members to identify opportunities for improvement for key clinical measures.
- Reports findings to other departments such as utilization review, infection control, and risk management.
- Serves as a working member of the clinic's quality committee; attends committee meetings and other pertinent meetings to ensure the organization's overall QI plan implementation and compliance.
- Plays a role in project facilitation and performance measurement involving organization wide assessment and change initiatives.
- Assists the clinical quality team on any ad-hoc tasks as required by the department.
- Keeps abreast of current JCAHO standards and other accreditation standards, and the latest quality techniques in health care.
- Demonstrated initiative, ability to work with others, and good professional judgment.
- Ability to work independently and organize time effectively.
- Excellent written and verbal communication skills.
- Knowledge of continuous quality improvement principles.
- Ability to understand and use analytical reasoning to interpret and take action on patient care data.
Education, Experience, Licensure/Certification and Skills/Abilities Related Requirements:
- A least three years of clinical nursing experience preferred
- Strong technical skills and experience using reporting software
- Certification in health care quality, patient safety or related accreditation entity preferred, required within 2 years of employment.
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