This position will remain open until a successful candidate has been identified.
UCSD Layoff from Career Appointment: Apply by 12/22/2017 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor. Eligible Disability Counseling and Consulting services (DCC) or Special Selection clients should contact their Vocational Rehabilitation Counselor for assistance.
This is an exciting opportunity for the right individual to be actively involved in the Quality Program for our existing Managed Care and new Medicare ACO Program. This is a great opportunity for someone to help develop a system-wide approach to population health and health maintenance outreach. Reporting to the Assistant Director of Health Services, the Quality Improvement Specialist is responsible for managing the activities of multiple complex quality improvement initiatives with a focus on program development, team facilitation, project management and data management.
This position involves the establishment and supervision of processes (e.g., performance improvement, data validation, etc.) to achieve the optimal degree of excellence in the services rendered to every patient. Evaluation of practice operates within the parameters of patient outcome, cost-benefit in care provision, and patient access to the healthcare delivery system. Provides for internal strategic planning efforts and implementing continuous quality improvement programs. The QI Specialist applies skills and experience as a seasoned quality data and / or improvement (QI) specialist to projects of medium size at all levels of complexity, or to portions of large projects.
Supports designated clinical areas on data management including establishing systems to acquire data.
Develops appropriate data reporting structures to support quality reviews for new initiatives.
Analyzes and interprets data at most levels of complexity and summarizes statistical findings. Develops corresponding reports, dashboards, presentations, and action plans. Participates in development of executive summaries.
Identifies statistical trends, and potential issues in patient care and services. Works collaboratively on highly complex projects in assigned clinical departments to develop corrective plans, and monitor their effectiveness.
Within the Population Heath Care Team, works on creating a sustainable outreach program for quality initiates and patient engagement as it relates to the ACO.
Performs timely and accurate reporting of quality data to appropriate internal departments and outside agencies.
Collaborates on clinical and technical project teams to apply complex QI models and techniques to improve clinical care and patient safety; develops plans to improve quality of patient care.
Researches best practices and develops proposals for improvements in the data collection and reporting processes and / or systems.
Provides advice and recommendations on complex clinical QI issues of functionality, efficiency, and program development.
Other duties as assigned.
Bachelor's degree in nursing (BSN) or a combination of comparable clinical education and/or experience.
RN license issued by the State of California.
Three (3) years or more of relevant experience including Case Management experience.
Experience and proven success in QI standards, clinical chart review and abstraction, and regulatory requirements.
Knowledge of P4P (pay-for-performance) and HCC processes and reporting requirements.
Demonstrated experience implementing quality assessment and control protocols with ability to monitor and evaluate results.
Advanced proficiency with the Microsoft Office suite of products including Excel, PowerPoint, Visio, Word, and Outlook.
Basic knowledge of DMHC, CMS, HEDIS, TJC, and NCQA requirements and standards.
Strong organizational skills with ability to handle multiple projects and changing priorities and deadlines.
Outstanding written and oral communication skills with ability to lead discussions and make presentations to clinics, committees, and Medical Group administration.
Excellent interpersonal skills with the ability to work in a team environment.
Experience in Managed Care and familiarity with Managed Care policies.
ACO (Accountable Care Organization) experience.
ACM and/or CCM certificate.
Knowledge of EPIC and database management.
Must be able to work various hours and locations based on business nee
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