Quality Improvement Specialist/Health Navigator
Company: RWJBarnabas Health Corporate Services
Location: Franklin
Posted on: January 15, 2021
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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
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