RN - Quality Improvement Coordinator
Hybrid Work Location: partial in office and partial remote.
The Quality Improvement RN Coordinator works with the Quality Management team, inter-departmentally and with business partners to design, implement, and maintain the highest level of accreditation for Utilization Review Accreditation Commission (URAC) and other corporate quality recognition programs; develops quality improvement plans for specific accountable measures that are solution focused, customized to various provider models including Patient Centered Medical Home. This is predominately accomplished through ownership and accountability for data management, analytics, identification of improvement opportunities, and reporting for assigned clinical quality improvement programs/topics. The RN Quality Improvement Coordinator provides support and guidance to the overall team and supports leadership in the development, implementation, and monitoring of the QI Program, Quality Plan, and QI Annual Evaluation.
- Function as department subject matter expert on data, databases, and systems used to analyze reported data from various sources, identify opportunities for improvement, plan and recommend action steps and assess results in a continuous cycle of quality improvement. Consult with data reporting team to obtain revised and updated data as needed.
- Research and review highly technical and analytical documentation related to quality and clinical standards, metrics, and methodology and translate into relevant and actionable language for audiences within the department, other Health Alliance departments, and external business partners.
- Establish and maintain effective relationships with key individuals from Health Alliance and external clients or vendors to develop a mechanism to identify and resolve QI issues; organize and facilitate meetings and committees.
- Present quality findings and recommendations to management and internal committees/teams clearly, succinctly and based on accurate outcome measurements when measurements are necessary.
- Annually review changes in standards for the preparation and maintenance of accreditation through the URAC and implement changes in quality programs on schedule.
- Collaborate with Star Coordinators to ensure compliance with CMS quality improvement requirements.
- Provide education to all providers (facilities, DME providers, physicians, mid-level providers and others as part of the clinical team) to improve compliance with nationally recognized clinical guidelines self-management for the chronically ill and increase wellness for all Health Alliance members as measured by HEDIS and other measures.