Performs multiple coordination and support functions associated with external quality review activities. Position will assist in providing team-directed guidance and support to the contractor regarding various aspects of quality improvement including: development, implementation, measurement, and evaluation.
Performs research and development, coordination, monitoring of various activities, and project management duties related to the external quality review organization (EQRO) contracts.
Supports other functional areas of the organization as directed and performs other duties as assigned.
Major Duties and Responsibilities:
Participate in annual compliance reviews including but not limited to: the development of quality assessment tools, scheduling, pre-assessment documentation review, onsite review activities and report preparation.
May serve as Team Lead for a specified task area and needs to demonstrate an understanding of the clinical aspects and evidence for the measures and clinical best practices for that task.
Assist in the overall assessment, planning, development, implementation, and evaluation of specific projects and quality improvement activities as necessary to fulfill contract deliverables.
Identify, present, and discuss contract progress and issues relating to project and assist in the implementation of solutions.
Coordinate, lead and/or participate in on-site healthcare provider review visits.
Coordinate, lead and/or participate in remote, desk reviews of healthcare provider care services, plans and progress with said quality improvement plans.
Assist in generating reports of project activities, outcomes as assigned or directed.
Establish and maintain effective relationships with healthcare providers and related groups.
Coordinate and participate in organizational and customer meetings.
Ability to provide technical assistance both onsite and virtually to healthcare providers and stakeholders.
Coordinates and conducts quality studies including medical record review.
Participate in ISO processes as required.
Perform other duties as assigned.
Knowledge, Skills & Attributes:
Knowledge of the healthcare system/environment.
Basic computer skills (MS Word, Excel).
Familiarity with medical terminology.
Willingness to travel approximately 35 percent.
Knowledge and understanding of NCQA standards and HEDIS.
Excellent written and verbal communication skills.
Educational presentation skills.
Strong team leadership and project management skills.
Ability to work on multiple projects simultaneously and ability to effectively deal with changes to project requirements.
Ability to work in a team environment while possessing strong self-directed skills.
Attention to detail including excellent planning and organizational skills.
Strong customer service orientation, for both internal and external customers.
Takes the initiative to remain current with relevant clinical topics and managed care performance improvement issues.
Education and Experience:
Licensed Registered Nurse required; BSN or greater preferred.
Minimum of two years’ experience in a clinical/health care setting required.
Experience in managed care, health care quality improvement and project management preferred.
Facilitator experience preferred.
Educational presentation experience preferred.
Behavioral Health Experience preferred
Long Term Services and Support--5 years’ experience preferred
Telecommuting is allowed.
Internal Number: 201901
Qsource is a nonprofit, healthcare quality improvement and information technology consultancy headquartered in Memphis, Tenn. We provide services throughout 12 states: Alabama, Arkansas, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Mississippi, Missouri, Nebraska,Tennessee and soon to Ohio.