Quality Improvement Specialist-Associate

Under direct supervision, responsible for performing a variety of clinical support functions for the outpatient setting including patient outreach, care gap analyses, and patient follow up to support the value-based care model.

• Performs patient chart reviews to identify opportunities in patient care to satisfy HEDIS measure gaps.
• Maintains systems for storing and tracking HEDIS medical record documentation
• Documents in the Electronic Medical Record
• Outreaches and requests charts and medical records from other facilities to close gaps in pre and post care for value-based patients with quality needs
• Scans or uploads medical records into payor databases
• Performs patient outreach to schedule Annual Wellness Visits and Follow up appointments to fill gaps in care
• Performs pre-visit evaluations that identify gaps in care for the clinical team and post-visit evaluations that identify gaps in care after the visit
• Identifies, tracks, and follows up on gaps in care that cannot be or were not closed in the clinic
• Performs medication adherence reviews to identify and mitigate barriers to patients not taking their medication
• Coordinates and assists in processing hierarchical condition category attestation forms from payors
• Performs all other duties as assigned

• Demonstrates the ability to support the mission, vision and patient promise throughout all interactions, The UT Health Way.
• Demonstrate the ability to communicate effectively, written and verbally.
• Demonstrates analytical thinking – this role requires analyzing information and using logic to coordinate work within schedule constraints and handle emergent requirements in a timely manner.
• Demonstrates the ability to participate as an integral part of the interdisciplinary healthcare team in providing the highest quality of care to the patient, The UT Health Way.
• Demonstrates a working knowledge of healthcare Effectiveness Data and Information Set (HEDIS) measures for which UT Health is responsible for under shared savings programs
• Demonstrates working knowledge of the electronic health record

EDUCATION:

HS Diploma or GED equivalent

PREFERRED:

MA experience and experience working in a clinic.