Quality Improvement Specialist

Job Description:
Quality Improvement Specialist

Reports to:

Chief Quality & Compliance Officer

Summary:

As the largest pediatric clinic in Jacksonville, serving 11 locations with nearly 45,000 patients, Angel Kids Pediatrics believes that caring for children is a continual process, and should not be limited to just doctor office visits during regular business hours. We believe that by providing excellent medical care in a family and community-based environment, we can grow healthy children who will become healthy adults.

We uphold the highest standards of a patient-centered medical home that provides quality, personalized and effective medical care as if each family was part of our own.

Equity, innovation, and inclusion guide our growth and strategy. We are looking for individuals who are passionate about, and committed to leading efforts to provide culturally relevant care, reducing health disparities, and helping build a diverse and inclusive team environment.

Angel Kids is seeking a full-time Quality Improvement Specialist, to join our team located at our corporate office in Jacksonville.

• Coordinate monthly meetings with managed care companies and work directly with managed care companies.
• Analyze various monthly reports and identify quality improvement needs.
• Run reports through Office Practicum and compare to insurance reports provided.
• Conduct chart reviews and claim corrections (if needed).
• Coordinate appropriate training needs across practice, based upon measured outcomes.
• Create, document, and implement policies and procedures (as appropriate).
• Conduct various training sessions (individually and collectively) for new quality improvement initiatives.
• Identify research, gather and analyze data from multiple internal and external sources in order to compare, contrast and synthesize information.
• Assists with identifying statistically significant patterns and trends.
• Prepares and presents reports and recommendations for the QI team.
• Closing care gaps and reconciliation of HEDIS measures.
• Assume leadership in identifying, assessing and refining tools, systems, databases and data elements needed for completing thorough analysis of clinical and claims data.
• Monitor and enforce no show and discharge policies for all patients
• Track reoccurring or unnecessary utilization of the emergency department and coordinate follow up care/education for all patients.
• Monitor and report all coordination of care for patients with chronic conditions practice wide.

• Analytical Synthesizes complex or diverse information;
  Collects and researches data;
  Uses intuition and experience to complement data;
  Designs work flows and procedures.
• Problem Solving Identifies and resolves problems in a timely manner;
  Gathers and analyzes information skillfully;
  Develops alternative solutions;
  Works well in group problem solving situations;
  Uses reason even when dealing with emotional topics.
• Planning/Organizing Prioritizes and plans work activities;
  Uses time efficiently;
  Plans for additional resources;
  Sets goals and objectives;
  Organizes or schedules other people and their tasks;
  Develops realistic action plans.
• Quality Management Looks for ways to improve and promote quality;
  Demonstrates accuracy and thoroughness.
• Teamwork Balances team and individual responsibilities;
  Exhibits objectivity and openness to others' views;
  Gives and welcomes feedback;
  Contributes to building a positive team spirit;
  Puts success of team above own interests;
  Able to build morale and group commitments to goals and objectives;
  Supports everyone's efforts to succeed.
• Ethics Treats people with respect;
  Keeps commitments;
  Inspires the trust of others;
  Works with integrity and ethically;
  Upholds organizational values.
• Interpersonal Skills Focuses on solving conflict, not blaming;
  Maintains confidentiality;
  Listens to others without interrupting;
  Keeps emotions under control;
  Remains open to others' ideas and tries new things.
• Oral Communication Speaks clearly and persuasively in positive or negative situations; listens and gets clarification;
  Responds well to questions;
  Demonstrates group presentation skills;
  Participates in meetings.
• Written Communication Writes clearly and informatively;
  Edits work for spelling and grammar;
  Varies writing style to meet needs;
  Presents numerical data effectively;
  Able to read and interpret written information.
• Adaptability Adapts to changes in the work environment;
  Manages competing demands;
  Changes approach or method to best fit the situation;
  Able to deal with frequent change, delays, or unexpected events.
• Attendance/Punctuality Is consistently at work and on time;
  Ensures work responsibilities are covered when absent;
  Arrives at meetings and appointments on time.
• Dependability Follows instructions, responds to management direction;
  Takes responsibility for own actions;
  Keeps commitments;
  Commits to long hours of work when necessary to reach goals;
  Completes tasks on time or notifies appropriate person with an alternate…