Quality Improvement Coordinator SWHP
Company: Baylor Scott & White Health
Location: Temple
Posted on: February 21, 2021
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Job Description:
JOB SUMMARYThe Quality Improvement Coordinator SWHP works
directly with the Manager Quality Improvement SWHP to facilitate
the planning, coordination and implementation of quality studies
and improvement initiatives. The Coordinator provides overall
project support for QI studies and initiatives for the SWHP. This
position supports studies and initiatives by gathering data,
conducting research, maintaining records, tracking issues, and
coordinating activities. The Coordinator works collaboratively
across departments to manage the implementation of specific NCQA
quality standards and regulatory requirements and writes compliance
responses for regulatory agency and accreditation surveys. The
Coordinator is required to have extensive familiarity with key
elements of the corporate strategic plan, provide conformance to
regulatory requirements, contractual obligations and the corporate
policies of the SWHP QI program. This position will support
liaison(s) and integration of projects with SWHP Clinical teams and
SWHP network providers to improve the quality of care and service
to SWHP members.ESSENTIAL FUNCTIONS OF THE ROLE* Facilitate the
design, planning, and implementation of quality improvement studies
and initiatives. Design is based on scientific literature, quality
publications, and sound quality improvement methodology. SWHP
standard work procedures and industry best practices.* Serve as a
primary technical and process resource on all quality related
issues. Lead, facilitate, and manage studies and activities in
order to improve the overall delivery of health care services for
the SWHP. Support appropriate methodologies for collecting,
analyzing, validating, managing, and presenting data.* Manage
quality committee, subcommittee and work group meetings,
co-facilitate and lead meetings in conjunction with Medical
Director or work group chairperson.* Support clinical studies and
HEDIS improvements, abstract clinical data elements from
guidelines. Enter findings into applicable database and completes
data analysis when indicated.* Make professional visits to
practitioner offices/clinics to conduct medical record reviews and
provide information to practitioner office staff and practitioners
on HEDIS and other practitioner metrics.* Write professional
quality improvement reports for internal teams, NCQA CMS, and TDI,
newsletter articles, and practitioner/office staff educational
materials.* Train new and less experienced QI team members in
understanding and effectively utilizing the QI processes and tools,
such as facilitation, quality improvement methodology, data
analysis and communications.* Conduct outreach visits to
educate/advise practitioners on proper documentation, coding, and
billing of medical records according to HEDIS specifications.
Publish best practice and Friday Focus articles related to HEDIS
specifications and requirements to engage practitioners to actively
participate the QI programs/ plans for process improvement as it
relates to closing gaps in care and providing a higher quality of
care for our members.* Prepare annual review of department policies
and procedures and makes recommendations for updates based of
changing needs, trends, and regulatory changes.* Develop
performance improvement targets for quality and efficiency
measures, and make recommendations regarding two (2) or more
Performance Improvement Plans (PIP) for the QI division, governing
bodies (i.e. Texas DHHS), and the health plan per fiscal year.
Develop HEDIS Improvement Guide of best practices and billing codes
to promote appropriate documentation and coding for HEDIS
compliance.* Perform QI studies as related to trends identified via
utilization review activities, utilization patterns, audits, HEDIS
results, appeals, etc. Audit patient charts at provider offices via
onsite visits or EMR, analyzes trend reports, and preforms other
analyses to assist with the documentation of quality improvements.*
Examine medical records and quality related information necessary
for QI studies or activities, trend files and other performance
data sources to identify new quality issues and areas for
improvement.* Collaborate with Medical Director, Physician
Champion, and others to design and implement quality
studies.BENEFITSOur competitive benefits package includes the
following- Immediate eligibility for health and welfare benefits-
401(k) savings plan with dollar-for-dollar match up to 5%- Tuition
Reimbursement- PTO accrual beginning Day 1Note: Benefits may vary
based upon position type and/or level. QUALIFICATIONS- EDUCATION -
Bachelors or Equivalent Exp- EXPERIENCE - A minimum of 3 years
experience required- Clinical experience preferred
Keywords: Baylor Scott & White Health, Temple , Quality Improvement Coordinator SWHP, Other , Temple, Texas
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