Quality Improvement Specialist

The primary purpose of the Quality Improvement Specialist classification is to assist with the organization, planning, development, implementation, and coordination of a continuous quality improvement plan.  Assist with the coordination of internal and external quality assurance activities.  Oversee and maintain quality assurance of assigned home health care agencies, transportation companies, and suppliers of medical products, in order to provide diverse and individualized services to older adults in their homes.

Monitor, evaluate, and train agencies providing health care and transportation services to older adults to assist them in living independently in their homes.  Conduct official pre-certification, post-certification, and annual review site visits and audits at provider agencies to determine compliance with contract requirements.  Ensure compliance with federal, state, and local laws and contractual rules and regulations.  Prepare exit conference summary and structural compliance review, written plans of correction, reports, and correspondence for the agencies.  Monitor agency's plan of correction.  Provide technical assistance to agency administrators to assist in maintaining and improving regulatory compliance, quality practice, and consistency between planned and actual services.  Assist providers in maximizing their management and service delivery system efficiency and minimizing wasted effort.  Interpret program requirements for providers.  Develop and provide reports, forms, and data to assist agency administrators in managing service delivery.  Recommend when cautions to providers are warranted for substandard performance.  Take disciplinary action when necessary.  Recognize exemplary performance of agencies.  Develop and maintain tracking system for monitoring agency performance.  Develop forms and tools for formally evaluating agency.  Provide and maintain a pool of diverse service providers.  Design and update tools and documents for case managers to use when making provider awards to client care plans.
 
Resolve and negotiate client, caregiver, case manager, and provider complaints.  Investigate and verify information and make recommendations.  Resolve billing and invoice disputes between provider and client.  Calculate and approve adjustments to client and provider invoices.  Complete billing change forms.  Maintain accurate and up-to-date records and documentation in accordance with agency standards.  Develop and design systems to maintain client and provider relationships.  Serve as consultant and advisor to clients, agency providers, and case managers.
 
Assist in the development of mechanisms to assure best practice.  Facilitate workgroups to assist program teams with process improvement and development of program policies and procedures.  Conduct research and design flow charts, team charters, bar graphs, surveys, grids, etc. to assist in process and with presentations.  Facilitate team development activities.  Mediate interpersonal conflicts among staff.  Assist in the development, facilitation, and implementation of the agency's strategic business plan.  Facilitate workshops.  Assist program staff in developing purpose statements, services, and program performance measures.  Conduct orientation for new staff and students. 
 
Assist in the coordination of the Invitation to Bid for in-home care services, medical transportation, and central order contracts conducted in conjunction with the purchasing department.  Assist in developing goals and objectives to determine appropriate standards for services delivered.  Write and revise Conditions of Participation and Service Specifications for contracts.  Evaluate provider application packets for compliance with Invitation to Bid. Research and verify business history.  Complete and document reference checks for applicants.  Schedule and conduct pre-certification visit.  Evaluate agency's compliance with Invitation to Bid contract requirements.  Make decision to recommend agency for contract.  Maintain and update case management system. Communicate with general public to inquire about becoming a provider.  Maintain and update list of interested parties.  Assist in the gathering and analysis of program impact data.  Plan, design, conduct, evaluate, and analyze agency surveys.  Compile and generate reports from completed surveys.  Present results.  Attend meetings.  Coordinate and monitor assigned special agency projects. Participate in various advisory boards, task forces, councils, coalitions, and committees in the community.
 
These duties are illustrative only and you may perform some or all of these duties or other job-related duties as assigned.

Bachelor's degree in human service or related field with two (2) years of human service, social service or related experience; or any equivalent combination of training and experience.

No special license or certification is required.
 
Supervisory Responsibilities
None required.