Description
Join St. Francis-Emory Healthcare, a 376-bed community-connected hospital in Columbus, GA, that blends cutting-edge care with hometown purpose. As part of the ScionHealth network, St. Francis has been recognized and awarded multiple high-performing honors by U.S. News & World Report, and received multiple disease-specific certifications from the Joint Commission, and was a rated Top Large Hospital in Georgia. St. Francis also delivers advanced heart, orthopedic, and women's care services. At St. Francis, you will experience a culture of excellence where your work directly shapes the health of our community.
Job Summary
The Coordinator - Quality/Utilization Review/Performance Improvement supports the facility's quality and compliance programs by performing data collection, utilization review, performance improvement tracking, and reporting functions. This role assists in monitoring regulatory compliance, supports accreditation readiness, and collaborates with clinical leaders to promote effective, safe, and high-quality care delivery.
Essential Functions
- Collects, compiles, and analyzes clinical quality and performance data for reporting and benchmarking.
- Supports ongoing performance improvement initiatives by coordinating documentation, tracking action plans, and assisting with root cause analyses.
- Conducts concurrent and retrospective utilization reviews to ensure appropriate levels of care and adherence to payer guidelines.
- Prepares and submits utilization review reports and appeals as required.
- Assists in ensuring compliance with CMS, Joint Commission, and other regulatory standards.
- Participates in survey readiness activities and helps facilitate mock surveys or tracer audits.
- Maintains quality dashboards and scorecards under the direction of the Quality Department.
- Assists in policy and procedure review and document control activities. Coordinates interdisciplinary quality meetings, agendas, and follow-up activities.
- Serves as a resource to staff regarding quality metrics, documentation standards, and compliance expectations.
Knowledge/Skills/Abilities/Expectations
- Knowledge of regulatory and accreditation standards (e.g., CMS, Joint Commission, state agencies).
- Familiarity with quality indicators, benchmarking, and evidence-based improvement methodologies.
- Ability to review and abstract medical records for clinical appropriateness and quality compliance.
- Strong analytical, organizational, and communication skills.
- Proficient in Microsoft Office Suite and electronic health record systems.
- Ability to work independently and as part of a multidisciplinary team.
Qualifications
Education
- Associate's degree in Nursing, Healthcare Administration, or related field required.
- Bachelor's degree preferred.
Licenses/Certifications
- Licensed Practical Nurse (LPN), Registered Nurse (RN), or relevant clinical certification preferred.
- Certified Professional in Healthcare Quality (CPHQ) or Case Management (CCM/ACM) preferred.
Experience
- Minimum of 2 years of experience in healthcare quality, utilization review, case management, or performance improvement.
- Experience in a hospital or post-acute care setting preferred.