Quality Specialist

SUMMARY:

The Quality Specialist is part of a multidisciplinary care team that works to optimize the delivery of quality care within Gracelight Community Health (Gracelight). Under the direction of the Director of Quality, the Quality Specialist facilitates quality improvement projects to enhance the improvement of the organization. The scope of responsibility encompasses all settings of the organization, both clinical and operational. The QI Specialist will be responsible for coordinating, analyzing, and reporting findings, as well as developing tools to measure improvement. Daily work includes compliance with State, Federal, and health plan mandates.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

• Supports and implements the organization’s vision, mission, and values.
• Determines priorities to complete daily workload to ensure that all responsibilities are carried out in a timely manner.
• Answers phone calls and e-mails in a timely manner with excellent customer service internally and externally.
• Uses effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to promote improved quality and continuity of care.
• Assists in the compliance, accuracy, and timeliness of standards in accordance with CMS, NCQA, DHCS, Health Plan, and other federal regulations.
• Supports the Director of Quality in the coordination of the Quality Committee by ensuring timely preparation of Committee meeting presentations, minutes, and follow-up.
• Assists with grievances to respond, build, direct, and ensure improvement implementation and effectiveness of the organization's process initiatives.
• Must be able to manage diverse areas of understanding and interface effectively with all employees, employers, Gracelight’s personnel, and providers.
• Coordinates and completes special projects delegated by the Quality leadership team.
• Actively collaborates with other teammates to manage and meet the requirements of health center certifications including but not limited to the Patient Centered Medical Home (PCMH) and other certifications as required.
• Participates in the development and implementation of Quality goals, objectives, and process improvement tactics. Ensures all goals and objectives are met timely and effectively.
• Adheres to all company policies and procedures. Maintains a safe, clean, and organized working environment.
•  Assists in preparation of audits.
• Assists with orientation and training for new and existing employees as needed.
• Recommends and assists with workflow efficiencies to improve HEDIS, STARs, and IHA AMP scores.
• Attends ongoing internal and external training to apply to daily work.
• Refers any potential quality of care issues identified to QI leadership.

QUALIFICATIONS, SKILLS & ABILITIES:

• Bachelor’s Degree required. Healthcare background preferred.
• Advanced certification or licensure in health care or process improvement preferred (LVN, RN, SW, Project Management, LEAN, or Six Sigma).
• Certified Professional Healthcare Quality (CPHQ) certification preferred.
• A minimum of 3 years prior experience in a healthcare environment performing quality and process improvement duties.
• Demonstrates ability and flexibility to work in other areas of the organization as needed.
• Communicates clearly and concisely, both verbally and in writing.
• Self-sufficient and reliant.
• Demonstrates a willingness to learn new routines and methods and responds to changes in work as necessary.
• A genuine passion and deep appreciation for the mission of the Organization.
• Flexibility to work both remotely and onsite as needed, including the ability to attend impromptu meetings or handle urgent issues in person at any of Gracelight's locations.
• Strong organizational skills, with the ability to manage several projects at the same time.
• Ability to work effectively with all levels of the organization and stakeholders, including communication with clients, patients, and health plan executives in an utmost professional manner.
• Must be able to demonstrate a positive healthy attitude. Flexible and dependable.
• Fosters and promotes a culture of service excellence and accountability.
• Maintains and promotes a safe and healthy work environment.
• Excellent communication skills, both oral and written.
• Demonstrates proficiency in computer applications essential for the role.
• Ability to organize and prioritize work with minimum supervision.
• Ability to manage time efficiently and follow through on duties to completion.
• Understands and commits to maintaining the highest level of confidentiality.
• Ability to build a positive rapport with patients, staff, colleagues, and other external contacts.
• Excellent problem-solving skills required, including creativity, resourcefulness, timeliness, and technical knowledge related to analyzing and resolving clinical problems.
• Sensitivity to needs of culturally and linguistically diverse patient and employee population