Quality Coordinator

Description

The Quality Coordinator reports to the Chief Medical Officer and provides leadership for Valley Healthcare System, Inc. (VHcS)'s organization-wide quality and performance improvement program. The position works collaboratively with executive leadership, department managers, providers, and staff to develop and implement strategies that advance the VHcS mission and promote continuous improvement in quality, compliance, patient safety, risk reduction, and organizational performance.

The Quality Coordinator designs, plans, and implements performance improvement systems; collects, trends, and analyzes aggregate data; identifies best practices and improvement opportunities; and helps ensure that healthcare practices meet VHcS standards and applicable regulatory requirements. The position serves on the Quality Improvement Committee and the Risk Management and Compliance Committee and may lead special projects assigned by the Chief Executive Officer or Chief Medical Officer. The successful candidate demonstrates sound independent judgment, initiative, discretion, and a strong working knowledge of HIPAA and NCQA requirements.

Essential Duties and Responsibilities

Quality Leadership and Strategic Planning

• Lead visible, complex improvement initiatives and resolve quality issues of strategic importance to the organization.
• Develop and revise the annual Quality Improvement program, evaluation, and work plan; present these materials for review and approval.
• Integrate strategic and annual quality planning into organizational strategic and operating plans with broad-based participation.
• Develop a data-driven culture that supports compliance and continuous quality improvement through clear goals, measures, and accountability.
• Apply established quality and performance improvement methods to define objectives, identify stakeholders, develop action steps, and coordinate human, technological, and fiscal resources.
• Review organizational processes, policies, and procedures; identify best practices and improvement opportunities; and recommend changes based on findings.
• Evaluate Quality Improvement policies and procedures and recommend revisions to the Quality Improvement Committee as needed.

Performance Measurement Auditing and Reporting

• Conduct quality audits related to Uniform Data System reporting, Patient-Centered Medical Home standards, HEDIS measures, Meaningful Use requirements, and other applicable programs to establish baselines and monitor progress toward goals.
• Collect, prepare, trend, and analyze aggregate performance improvement and quality monitoring data for defined patient populations and clinical specialties.
• Present data and findings in clear written and graphical formats to the Chief Medical Officer, Chief Executive Officer, Quality Improvement Committee, and other departmental committees as directed.
• Review clinical documentation for completeness, accuracy, quality, and compliance; submit audit findings to the appropriate department within established timeframes.
• Identify audit outliers and potential quality concerns, develop corrective action plans, monitor corrective actions through follow-up audits, and recommend additional action when needed.
• Research clinical standards, benchmarks, and evidence-based criteria against which performance may be evaluated.
• Assist the Chief Medical Officer with provider documentation and quality audits at least twice annually and more frequently as needed.

Care Gaps Payer Quality and Patient Centered Care

• Coordinate quality initiatives and care-gap closure activities for VHcS patients enrolled in Medicaid and applicable managed care plans, including Peach State Health Plan, Ambetter, Wellcare, and CareSource, while coordinating appropriately with contracted partners supporting Medicare Advantage populations.
• Distribute patient appointment agendas and other quality documentation received from Optum, Peach State Health Plan, or other contracted partners to providers; track completion and return according to established workflows.
• Promote healthcare integration and the principles and standards of the Patient-Centered Medical Home model throughout the organization.
• Ensure that data collection methods and intervention plans are practical, feasible, and consistent with daily clinical and administrative operations.

Staff Support Training and Collaboration

• Coach and support staff in meeting milestones and completing quality improvement deliverables.
• Provide consultation, technical assistance, and training to multidisciplinary administrative and improvement teams on quality tools, methods, and measures.
• Analyze quality data to identify staff education and training needs through the performance improvement process.
• Coordinate and provide functional direction to Data Analysis, Medical Records, and Risk Management personnel in completing assigned quality improvement deliverables.
• Consult with executive leadership, department managers, providers, and other staff regarding quality, compliance, risk, and performance matters.

Compliance Risk Management and External Partnerships

• Remain current on regulatory requirements, professional standards, accreditation expectations, and industry practices that may affect VHcS operations.
• Support compliance with applicable federal, state, and local requirements and ensure that ethical standards, confidentiality guidelines, continuous quality improvement practices, and HIPAA policies are communicated and modeled consistently.
• Identify effective methods to reduce organizational, clinical, and operational risk.
• Serve as an active member of the Quality Improvement Committee and the Risk Management and Compliance Committee; attend scheduled meetings and lead meetings as assigned.
• In coordination with organizational leadership, identify and develop strategic partnerships with governmental, corporate, philanthropic, academic, and other organizations to advance quality and innovation and seek funding to strengthen quality management programs.
• Maintain current knowledge and competencies in quality management through relevant meetings, continuing education, professional development, and documentation of learning activities.
• Lead or assist with special projects coordinated by the Chief Executive Officer or Chief Medical Officer and perform other duties as assigned.

Requirements

• Bachelor's degree in social work, healthcare administration, business administration, or a closely related field from an accredited institution; a master's degree is preferred.
• Seven to ten years of progressively responsible managerial experience in a healthcare, social service, or business environment.
• At least five years of experience developing, implementing, and maintaining quality management systems encompassing quality assurance, performance improvement, and compliance activities.
• Experience with NCQA accreditation requirements and Medicaid quality programs is preferred.
• Demonstrated experience in performance improvement, statistical analysis, information systems, data visualization, and outcome measurement is strongly preferred.

Knowledge Skills and Abilities

• Working knowledge of continuous quality improvement, quality assurance, risk management, healthcare compliance, clinical documentation auditing, and corrective action planning.
• Knowledge of HIPAA, NCQA, PCMH, UDS, HEDIS, Medicaid managed care quality requirements, and other applicable healthcare standards.
• Ability to analyze complex quantitative and qualitative data, identify meaningful trends, and communicate findings through accurate reports, graphs, and presentations.
• Strong project management, facilitation, training, coaching, problem-solving, and organizational skills.
• Ability to collaborate effectively across clinical, administrative, and executive teams while exercising sound independent judgment.
• Strong written and verbal communication skills, attention to detail, discretion, and commitment to patient privacy.
• Proficiency with electronic health records, spreadsheets, databases, presentation software, and other tools used for quality measurement and reporting.

Compensation & Benefits

• Salary: $51,624.00 - $64,530 Annually
• Full Benefits Package includes: 100% employer-paid Medical coverage (valued at $10,000/year), Long-term Disability coverage, and free Dental and Vision services in our clinics. Additional Dental, Vision, and Short-term disability coverage is available for purchase at a reduce cost.

Compliance: Adhere to company policies and procedures and all Federal, State and Local medical service requirements. To include HIPAA Privacy & Security. 

Confidentiality (HIPAA): Every employee is required to sign a Pledge of Confidentiality. Failure to comply with our Pledge of Confidentiality can or will lead to immediate termination of employment. Confidentiality applies to a patient’s Personal Health Information (PHI) and includes written, oral, and electronic communications. Each employee has an obligation to maintain confidentiality after his or her employment/association with this facility ends.

Security (HIPAA): Every employee must protect their computer log-on and password. You must secure your work area prior to leaving it unattended for an extended period. You must log off your computer and secure your work area before leaving at the end of the day. If you are responsible for closing or locking files, securing equipment, or locking the building and do not comply with these requirements, you will be subject to reprimand and/or termination based on the infraction. We are required by law to protect patient privacy, identifiable patient information, and all properties containing such information. 

Physical Requirements: Requires prolonged sitting, standing, some bending, stooping, and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, and other office equipment. Requires corrected vision and hearing to normal range to record, prepare, and communicate appropriate reports. Frequent exposure to communicable diseases, toxic substances, and other conditions common to a clinic environment. Occasional evening or weekend work.