• Quality Improvement Associate

    Location US-NY-New York
    Posted Date 6 days ago(10/12/2018 11:24 AM)
    Job ID
    2018-12048
    # Positions
    1
    Facility
    ArchCare Advantage
    Experience (Years)
    1
    Category
    Administrative
    Work Days Per Week
    5
    Shift
    D
    Shift Start Time
    9
    Shift End Time
    5
    Type
    Full-Time
    # Hours
    7
  • Overview

    The QI Associate provides support to the QI Director in the development, implementation, and evaluation of the Plan’s overall Quality Improvement (QI) Program, to identify trends, prioritize projects, recommend improvements, and ensure compliance with regulatory requirements. Assists with the investigation of quality of care reviews, appeals, grievances, patient care issues, and participates in other QI activities including collection, organization and management of medical records for QI activities including but not limited to HEDIS, HOS, Star Rating Program, Appeals, Grievances, focused interventions and oversight of any delegated activities. The QI Associate 2 is cross trained in all QI Department tasks and activities but will each have primary responsibilities

    Responsibilities

    1. Assists the Director of Quality Improvement and the Quality Improvement Associate with the day to day activities of the QI Department, providing back-up during planned and unplanned absences. To this end the QI Associate 2 is cross-trained in all QI Department tasks and activities
    2. Shares responsibility with the QI Associate 1 for maintenance and updates the Appeals database and notifications library, insuring compliance with model notice guidelines and other regulatory requirements
    3. Maintains electronic and paper files of quality improvement projects assigned by QI Director
    4. Assists QI Associate in reservation of conference room and arrangements of technical set-up, preparation of print packets for Quality Improvement Committee and other departmental meetings
    5. Assists in the collection of documents including but not limited to annual HEDIS reporting, annual QI Program evaluation, quarterly part C & D reporting, medical record review and other QI functions
    6. Conducts mailings for health promotion activities
    7. Keeps track of interventions associated with the annual QI Project, Star Rating and HEDIS and provides monthly reports to the QI Director
    8. Under the Direction of the QI Director, initiates requests for HEDIS Roadmap, tracks and maintains versions of the various documents needed for Roadmap completion from internal and external contributors as well as set up of meetings to review and finalize roadmap documents for HEDIS compliance audit.
    9. Prepares spreadsheets for monthly Quality Incentive Program. Insuring reports from all the facilities have been received by the reporting date agreed upon and summary template and back-up documentation are forwarded to the QI Director
    10. Participates in day to day quality improvement activities including but not limited to collecting documents, reviewing data, auditing, monitoring, assisting with root-cause analysis and reporting
    11. Assists with the investigation of quality of care issues and appeals in a secondary role, including but not limited to requesting medical records for review, preparing the paper file to submit to internal and external review agencies, and communication of resolution to members and providers , ensuring compliance with processing time frames
    12. Participates in committee meetings as assigned by the QI Director
    13. Performs other duties as assigned by the Director of Quality Improvement

    Qualifications

    Minimum one year experience in a managed care setting or equivalent

    Basic knowledge of the quality improvement process and applicable regulatory requirements.

    Proficiency with Microsoft Excel, Word, Power point and Outlook is required, some Access desired.

    Minimum Associate degree required, BA Science preferred or other health related field

    Ability to read and interpret documents such as safety rules, operating instructions, and procedure manuals.

    Ability to write routine reports and correspondence.

    Ability to communicate effectively with groups of customers or employees of the organization.

    Good interpersonal, problem solving skills. Excellent oral and written communication skills.

    Ability to interact with all levels of staff in a diplomatic manner.

    Ability to multi task and be comfortable in a fast paced environment.

    Good prioritization skills, comfortable with deadlines

    Able to work independently or with minimal supervision; team player; resourceful

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