Assists the Quality Management Resources with the coordination and preparation of medical record reviews, which includes ongoing review of medical records.
Participates in meetings with administrative for the medical record collection process. Works with internal workgroups to monitor accuracy of designated abstracted records.
Participates in all activities with, vendors, consultants and auditors related to quality measures as mandated by regulatory bodies (e.g. Quality Improvement Organizations, PMDC, PHC, etc).
Quality improvement study design and implementation including selection of valid and reliable indicators, coordination of monitoring and evaluation activities, and medical record reviews. Analyze data and prepare concise, accurate and meaningful quality management reports in accordance with quality management principles. Provides data collection and report development support for quality improvement studies and performance improvement projects. Educate members, providers, vendors/partners, and Riverside staff members on best practices.
Development and implement innovative procedures to improve quality of work, quality of care, and quality outcomes and measures as mandated by regulatory bodies. Educate providers and other organizational departments in the improvement of member outcomes and satisfaction for assigned population(s).
Conduct quality related audits for delegated vendors and provider office visits to facilitate ongoing education and improvement to assigned populations. Participate in provider office clinic days, health fairs, and community events to ensure maximum member benefit, improved data collection.
Assists with provider and member interventions and incentive efforts, as needed. Supports the accomplishment of corporate strategic plans that achieve high impact and significant improvements in organizational performance. Supervises employees who lead or facilitate quality improvement activities, provide project management, data analysis and measurement of outcomes, document and report the results and accomplishments of quality improvement initiatives.
Oversees and monitors the development and implementation of the quality improvement program. Performs under minimal supervision with accountability for specific goals/objectives. Works with the Executive Director, Medical Director, and others to develop performance improvement targets for quality, service, and efficiency of the organization.
Provides leadership for implementing changes targeted at systems improvement. Measures and evaluates attainment of results. Applies, teaches, and skillfully uses techniques for system design, reengineering, quality improvement, outcomes measurement, and statistical analysis. Assures that improvement activities are documented and reported within the organization and externally as appropriate. Investigate patient complaints/grievances received from patients, family and HMO's.
Conduct QI audits/surveys as a way to recognize and/or identify potential quality issues or trends. Demonstrates problem solving, leadership, conflict management, and team building skills in order to ensure a productive work environment and achievement of goals.
Strong organizational, analytic and interpersonal skills Excellent written and verbal communication skills Ability to create reports and present data.
Detail and process oriented with focus on efficiency Pro-actively and consistently applies the regulatory and accreditation standards to assure that activities are reviewed and processed within guidelines.
Reports audit or clinical findings to appropriate staff or others in order to ensure appropriate outcome and/or follow-up for improvement as indicated.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment