Job Description
Description The Clinical Quality Manager will oversee quality improvement initiatives and projects that focus on improving the health care and services for Delta Health clinic patients. This manager will also ensure the clinics maintain compliance with appropriate accreditation, state, and regulatory requirements.
Position Responsibilities: - Responsible for quality program metrics, results, and reporting for all quality programs and value-based contracts including but not limited to MIPS, HEDIS, RMHP, Humana, United Healthcare, Monument Health, and any future enrollments in pay-for-quality programs.
- Act as the liaison and coordinate all collaborations between clinics and value-based contract representatives.
- Bring forth opportunities for care gap closure and collaborate with clinic managers on process improvement projects to address these gaps.
- Train staff and providers on how to capture and document quality measures.
- Collaborate with coding teams and providers to assess and analyze appropriate coding and supporting documentation as related to quality metrics (e.g., CPT II codes) and visit types (e.g., annual wellness visits).
- Responsible for compliance, policy/process review, and on-going change management regarding program requirements for Rural Health Clinic certification and Patient Centered Medical Home accreditation.
- Work alongside clinic managers to ensure compliance with DNV requirements for Provider Based Clinics.
- Liaison between hospital departments and clinics for process improvement and issue resolution.
- Create and manage the provider quality review process including regular peer review activities.
- Collaborate with hospital quality staff regarding Hospital Transformation Program (HTP) requirements that relate to the clinics. Implement clinic staff training and process improvement projects related to HTP.
- Acts as patient advocate and addresses patient satisfaction/complaint resolution.
- Responsible for assuring customer/patient service needs are met. Monitors and analyzes patient feedback and satisfaction surveys to gauge quality of care and identify areas for improvement.
- Plans and initiates process improvement as related to cost reduction opportunities.
- Involved in the planning and implementation of strategic plan integration with DH goals.
- Supports clinic standardization.
- Plans, evaluates, recommends and implements new initiatives when appropriate.
- Evaluate and analyze data to assess the quality of healthcare services provided by the clinic.
- Ensure that the clinic's practices align with healthcare regulations and standards.
- Work closely with healthcare providers, administrators, and other relevant personnel to understand their data needs and provide insights that can enhance patient care.
- Contribute to ongoing efforts to improve clinic processes and patient care by providing data-driven recommendations for quality improvement initiatives.
- Create visual representations of data through charts, graphs, and dashboards to help stakeholders understand complex information.
- Generate regular reports summarizing key findings and insights.
- Provide daily, weekly and monthly data to outpatient leadership and the COO.
- Stay updated on industry trends, new tools, and emerging technologies to enhance your analytical skills.
- Builds strong positive communication with physicians and works as a team to enhance the success of the clinic.
- Maintains complete confidentiality regarding medical records and personal information.
- Other duties as assigned
Requirements Required Qualifications: - High School diploma or GED equivalent.
- 2+ years of data analysis or healthcare experience
- Intermediate level proficiency with Microsoft Excel.
Preferred Qualifications: - Bachelor's degree in Healthcare Administration, Business or Analytical field.
- Colorado RN license
- 2+ years' experience in a healthcare/managed care environment.
- 1+ year experience working in a Quality Improvement department.
- Familiarity with NCQA regulations.
- Experience managing multiple projects.
Skills and Abilities: - Excellent communication and interactive skills, both written and verbal.
- Ability to plan, organizes, coordinate, motivate, and direct operations of department personnel.
- Technical experience with personal computers, mini-computers, and computer networks preferred.
- A decisive self-starter, with a positive attitude.
- Ability to provide guidance and support to staff through team building and mentoring.
Delta Health
Job Tags
Contract work,