Quality Specialist

SUMMARY:

The Quality Specialist is part of a multidisciplinary care team that works to optimize the delivery of quality care within Gracelight Community Health (Gracelight). Under the direction of the Director of Quality, the Quality Specialist facilitates quality improvement projects to enhance the improvement of the organization. The scope of responsibility encompasses all settings of the organization, both clinical and operational. The QI Specialist will be responsible for coordinating, analyzing, and reporting findings, as well as developing tools to measure improvement. Daily work includes compliance with State, Federal, and health plan mandates.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

• Supports and implements the organization’s vision, mission, and values.
• Determines priorities to complete daily workload to ensure that all responsibilities are carried out in a timely manner.
• Answers phone calls and e-mails in a timely manner with excellent customer service internally and externally.
• Uses effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to promote improved quality and continuity of care.
• Assists in the compliance, accuracy, and timeliness of standards in accordance with CMS, NCQA, DHCS, Health Plan, and other federal regulations.
• Supports the Director of Quality in the coordination of the Quality Committee by ensuring timely preparation of Committee meeting presentations, minutes, and follow-up.
• Assists with grievances to respond, build, direct, and ensure improvement implementation and effectiveness of the organization's process initiatives.
• Must be able to manage diverse areas of understanding and interface effectively with all employees, employers, Gracelight’s personnel, and providers.
• Coordinates and completes special projects delegated by the Quality leadership team.
• Actively collaborates with other teammates to manage and meet the requirements of health center certifications including but not limited to the Patient Centered Medical Home (PCMH) and other certifications as required.
• Participates in the development and implementation of Quality goals, objectives, and process improvement tactics. Ensures all goals and objectives are met timely and effectively.
• Adheres to all company policies and procedures. Maintains a safe, clean, and organized working environment.
• Assists in preparation of audits.
• Assists with orientation and training for new and existing employees as needed.
• Recommends and assists with workflow efficiencies to improve HEDIS, STARs, and IHA AMP scores.
• Attends ongoing internal and external training to apply to daily work.
• Refers any potential quality of care issues identified to QI leadership.