Clinical Quality Improvement; QI Lead, HYBRID

Job Description

Clinical Quality Improvement (QI) Lead, HYBRID - )

Description The Clinical Quality Improvement (QI) Lead in collaboration with HSCSN Quality Assurance leadership leads the development, planning, and implementation of QI initiatives to ensure the delivery of quality health care and services. The QI lead will also support quality oversight, assessment, and NCQA compliance initiatives. She/he will be a subject‑matter expert in quality improvement and quality assurance and will be responsible for working with internal and external stakeholders.

• Bachelor's Degree – Ideal candidate should hold bachelor’s degree with public health background or other health related academic credentials and clinical background (RN, LPN, social worker etc.) (Required)
• Master's Degree in MSN, MPA, or MPH. (Preferred)

• 2 years of experience in developing, implementing, and evaluating clinical QI/PI initiatives, NCQA Accreditation, and HEDIS in a MCO (Required)
• 2 years of professional clinical experience. (Preferred)

• Ability to work under pressure independently, strong organizational and analytical (qualitative/quantitative analysis) skills is required.
• Experienced in facilitating and coordinating various QI work groups including HEDIS trend analysis, developing and implementing various initiatives.
• Demonstrated project management skills with the ability to handle multiple concurrent projects.
• Ability to work effectively with providers and multidisciplinary teams across departments.
• Experience in NCQA accreditation readiness activities (managing accreditation project plan, supporting team in reviewing/writing NCQA compliant analysis, preparing materials for survey etc).
• Experience with Medicaid regulatory compliance and external quality review organization (EQRO) activities such as managing Performance Improvement Projects (PIPs).
• Excellent written and verbal communication skills. Must be able to understand and use CQI principles/tools (Institute for Health Care Improvement's Model for Improvement).
• Knowledge of computer applications MS Suite (Word, Excel, PowerPoint, Adobe Pro, Outlook).

• Registered Nurse Licensed as a Registered Nurse (RN). (Preferred)
• CPHQ preferred.

• Participates and coordinates quality improvement performance measures including but not limited to:
• Analysis (Quantitative and Qualitative)
• Performs root cause analysis to assess low performance on chosen indicators, sets SMART aims with appropriate stakeholders and identifies key drivers for success.
• Identification of opportunities for improvement on internal quality outcome measures (KPI, HEDIS, CAHPS etc.) and collaborate with various teams to design, implement, and proactively monitor outcomes.
• Maintains expertise in continuous quality improvement principles and concepts.
• Design methodology, collect and interpret data, conduct clinical and statistical analyses, and monitor outcomes.
• Acts as a project leader by overseeing, coordinating, monitoring, and reporting on assigned projects and quality workgroup.
• Prepares detailed project plans including work plans, resources requirement, time frames, and methodology to achieve project objectives.
• Reviews project status at each phase, identifies variances from approved timetables, and proposes modified time frames.
• Collects, analyzes, and acts upon quality outcomes data, with respect to members and providers to effectively manage care including measurement of specific procedures, and the development, implementation, and evaluation of interventions.
• Analyzes member/provider survey data and identify opportunities to improve results.
• Participates and lead discussions, facilitate trainings related to QI tools and NCQA accreditation.
• Support HEDIS inventions/initiatives.
• Partners with Business Analysts, Business Informatics specialists, and other available resources (i.e. consultants) to develop needed reports to assess outcome and process measures needed for improvement work.
• Develop targeted/general member and provider educational interventions to support and improve specific QI…