Clinical - Quality Improvement Coordinator I - 211125

Job Profile Summary
Position Purpose: Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes.

Education/Experience: Bachelor s degree in nursing preferred. 2+ years clinical, quality management or healthcare related experience. At least one year experience in quality function in a healthcare setting.

License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. Utilization management certification preferred. Certified Professional in Healthcare Quality preferred.

Responsibilities
Perform duties and functions to comply with quality improvement programs according to state requirements.
Support Quality Assurance Performance Improvement work plan/initiatives.
Schedule and assist with committee and sub-committee preparation.
Assist in investigation and resolution of member quality of care complaints.
Audit medical records and monitor performance measures for health care risk management, sentinel events and trends.

For PA H&W only:
Responsible for overseeing reporting and outcome measurement and HEDIS data collection, serving as point person between the Department and the Department s EQR contractor."

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Job Profile Summary Position Purpose: Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes. Education/Experience: Bachelor s degree in nursing preferred. 2+ years clinical, quality management or healthcare related experience. At least one year experience in quality function in a healthcare setting. License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. Utilization management certification preferred. Certified Professional in Healthcare Quality preferred. Responsibilities Perform duties and functions to comply with quality improvement programs according to state requirements. Support Quality Assurance Performance Improvement work plan/initiatives. Schedule and assist with committee and sub-committee preparation. Assist in investigation and resolution of member quality of care complaints. Audit medical records and monitor performance measures for health care risk management, sentinel events and trends. For PA H&W only: Responsible for overseeing reporting and outcome measurement and HEDIS data collection, serving as point person between the Department and the Department s EQR contractor."
Story Behind the Need
What is the purpose of this team? Describe the surrounding team (team culture, work environment, etc.) & key projects. Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?		Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related to clinical initiatives such as health fairs and communication with agencies and providers. Collaborative culture. Key project to complete AHCCCS Medicaid QOC investigations. Systems Word, teams, outlook, power point, excel, one drive, one note & specialized report system
Typical Day in the Role
Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD). What are performance expectations/metrics? What makes this role unique?		Receive 1-3 QOC investigations daily that are due 30 days from the assignment date. Reviewing medical records, provider policies/manuals and statutes to ensure providers are rendering appropriate care to our members per the guidelines. Writing an investigative report of findings and submitting reports. Expectation to complete 1 investigative report per day. The role is unique as it requires clinical knowledge to be able to identify quality concerns and develop quality improvement plan to address the concerns with the provider.
Candidate Requirements
Education/Certification	Required:			Preferred: Bachelor s degree in nursing or license counselor/ SW preferred.
Licensure	Required: RN			Preferred:
Years of experience required: 3+ years of clinical, quality improvement or healthcare experience. MUST have BH or physical health setting experience. 2+ years of experience in quality function in a healthcare setting. Disqualifiers: No clinical BH or physical health experience Additional qualities to look for: Self driven, fast learner, critical thinker
Top 3 must-have hard skills stack-ranked by importance		1	Clinical knowledge
		2	Critical thinker, independent work, tech savvy
		3	Self driven
Candidate Review & Selection
Shortlisting process Candidate review & selection Interview information Onboard process and expectations		Projected Manager Candidate Review Date:			24 48 hours
		Type of Interviews:			Teams CAMERA ON
		Required Testing or Assessment (by Vendor):			Agencies perform - Computer literacy test Attach as separate document
Next Steps
Do you have any upcoming PTO?		No
Colleagues to cc/delegate		Jessica Isham & Jefferson Manzano
Compliance Questions