Quality Improvement Specialist/Health Navigator

Company: RWJBarnabas Health Corporate Services
Location: Franklin
Posted on: January 15, 2021

Job Description:

Job Summary: As a Quality Improvement Specialist, this role will develop and monitor various quality improvement initiatives with particular emphasis on best practices and compliance with state and federal regulatory and accreditation requirements. Quality Improvement Specialist will act as a voice for our members, guiding the development and improvement of comprehensive systems of care that will help others live healthier lives. Quality Improvement Specialists goal will be to achieve transformational and sustainable outcome improvements using project/program management; developing process and workflows; adopting evidence based best practices; utilizing quality/performance improvement tools; and High Reliability Organization principles (HRO). This position will also assist in the development and gathering of clinical metrics for the unit, and will work to help improve HEDIS, STARS, and any other clinical metrics by partnering with our Employed Medical Group & Community Partnered Physicians. Essential Functions: * Collaborates with providers, community-based services, and internal departments to coordinate care and assist members with adequate access to care * Participates in Quality Management Program by identifying improvement opportunities related to HEDIS /STARS, including performance and through documentation of clinical services. * Act as a liaison between the Payors and the Health System to improve the Quality performance for both risk and non-risk based population. * Identify the opportunity in various pay for quality or pay for performance program and manage the operational roll out and track the program s success throughout the year. * Lead and possess deep understanding of the ACO-Quality Metrics Reporting (GPRO) along with other State and CMS led quality initiative, i.e. CPC+, Primary Care First, etc. * Contributes to departmental and corporate goals through ongoing execution of care gap closures and associated member health outcomes improvement. * Conducts barrier analysis calls to specific member populations to determine any systemic reasons for low performance. Assists in the development of interventions to address identified barriers. * Develop scope and plan for improvement initiatives, acquiring stakeholder buy-in and leadership support; can communicate approach to outside stakeholders unfamiliar with improvement tools and methodologies * Use project management skills to develop project plan and timeline for quality improvement activities; and establishing metrics and milestones effectively track deliverables * Help cultivate a team culture of continuous process improvement and transparent accountability for clearly defined outcomes Job Requirements: * Two or more years of Professional/Clinical experience, including responsibility for continuous improvement and operational excellence * Experience with HEDIS/STAR quality measures * Strong organizational and problem-solving skills with excellent verbal, written, communication and presentation abilities * Knowledge of Microsoft Office, including Word, Excel, Outlook and PowerPoint * Knowledge and experience with the current community health practices for the all population inclusive of pediatric and adult population * Experience managing member information in a shared network environment using paperless database modules and archival systems * Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems * Previous health education or case management experience * Ability to work independently with minimal supervision in achievement of departmental goals for engagement and productivity * Ability to travel to various parts of New Jersey to visit the Physician/Physician Groups Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. We offer a great work environment, competitive rates and excellent benefits, including: Medical/Dental/Vision plans 401 (k) Vacation/Personal/Holiday/Sick Time Off Short & Long Term Disability Basic Life & Accidental Death Insurance Tuition Reimbursement Health Care/Dependent Care Flexible Spending Accounts RWJBarnabas Health is the most comprehensive health care delivery system in New Jersey and the state s second largest private employer with more than 32,000 employees, 9,000 physicians and 1,000 residents and interns. The system includes eleven acute care hospitals, three acute care children s hospitals and a leading pediatric rehabilitation hospital (Children s Specialized Hospital).

Keywords: RWJBarnabas Health Corporate Services, Franklin , Quality Improvement Specialist/Health Navigator, Healthcare , Franklin, Tennessee