JOB SUMMARY:
The Performance Improvement Specialist is responsible for directly assisting Premier Health Network (PHN) physicians and practice staff in meeting clinical quality measures, closing Healthcare Effectiveness Data and Information Set (HEDIS) gaps, and improving the overall quality of the attributed patient population in value-based care agreements. This role is also responsible for improvements in clinical measurement outcomes for promotion of the highest quality standards.
QUALIFICATIONS:
Minimum of one (1) year experience working in healthcare quality or practice environment required.
Minimum of one (1) year utilizing professional certification in directly related medical/healthcare role preferred.
Previous experience developing relationships and communicating directly with providers in a healthcare environment and/or role required.
EDUCATION:
Bachelor of Science or Bachelor of the Arts required, preferably in Healthcare related field
LICENSURE/CERTIFICATION:
Professional certification in medical/healthcare field required.
Valid driver's license and current automobile liability insurance required. Report of Motor Vehicle Record for past five (5) years required.
EXPERIENCE:
Two (2) year experience working with physicians to improve clinical quality strongly preferred.
Strong experience with clinical information systems and software.
Previous experience in a physician practice with medical coding and/or medical records highly desired.
Prior experience with Electronic Medical Records required.
Knowledge, skills, abilities:
Knowledge of medical terminology required.
Knowledge of CMS Stars, HEDIS clinical quality measures and healthcare metrics required.
Excellent customer service skills.
Critical thinking skills with cognitive ability to understand and analyze complex data using quality measure logic.
Must be detail oriented.
Must have excellent communication (verbal and written) and interpersonal skills for dealing with all levels of personnel (including clinical and IT).
Leadership and change management skills.
Strong skills with project management, clinical data abstraction, developing process improvements and organizational and analytical skills.
Ability to speak persuasively before individuals and groups.
Ability to proactively drive quality performance.
Ability to work independently and as part of a team.
Demonstrated problem solving skills.
Proficient with Microsoft office software to include Word, Excel, and PowerPoint.
Ability to multi-task.
Ability to convert abstract strategic opportunities into action.
Strong self-motivational skills and autonomy required.
Job Specific Major Areas of Responsibility:
*Reporting and communicating results – 15%
1. Monitors key internal and external clinical quality metrics reports including but not limited to, provider dashboards, performance based compensation reports, utilization reports and any other performance reports.
2. Supports PHN data staff in collaborating with health plan representatives to determine the accuracy of reports detailing PHN physicians’ clinical quality performance.
3. Maintains a current database that produces quality progress reports.
4. Reports discrepancies, quality metric performance and/ or other provider/practice related issues to Director of Quality.
5. Work in collaboration with quality improvement and population health staff with practices and providers to achieve quality metric improvements, educational opportunities and performance based issues.
6. Report all workflow based barriers, issues and/or educational opportunities in practices or provider offices to Director of Quality.
7. Work with Director of Quality to identify any compliance or performance based issues within provider practice areas in need of evaluation for workflow redesign.
8. Support workflow efforts of Director of Quality through collaboration between roles, in an effort to enhance quality provider practice performance, close gaps in care, and improve patient outcomes.
9. Communicate with Director of Quality consistently regarding status updates, role and support role updates, and all other operationally related issues or communications deemed necessary.
10. Participate and provide broad scale updates to all quality and population health staff during staff meetings.
*Determination of PHN practice and provider adherence to clinical quality guidelines – 30%
1. Leads physician practice staff in identifying opportunities for quality performance improvement and developing plans to support making the recommended improvements in regular in-person and virtual one-on-one meetings.
2. Researches PHN physician documentation to determine opportunities for coding improvement (i.e. the importance of coding to the level of highest specificity) and communicates improvements for increased physician compliance.
3. Assists Director of Quality in developing strategies for increasing contracted health plan and Clinically Integrated Network (CIN) physician quality reporting scores and improving earning potential of reward money based on PHN physician performance.
4. Develops and deploys targeted training to physicians and their staff to improve patient outcomes and increase clinically valued integrated networks.
5. Coordinates with physician specialty offices to coordinate care and ensure patient follow up.
6. Supports or conducts pre-visit planning reviews for practices.
7. Identifies underperforming physicians through quality performance data which require outreach from PHN leadership.
8. Supports quality improvement activities through active participation in practice education, data management and reporting, health insurance incentive programs, population health management, and other value-based reimbursement programs.
9. Develops and updates educational materials for new provider and staff orientation, ongoing ad hoc provider education, and clinical staff education.
*Closing HEDIS gaps – 40%
1. Assists physician practices in meeting the CIN’s organizational quality and efficiency goals through optimizing practice workflow and focusing on patient and provider engagement.
2. Provides ongoing support to clinical informatics specialists and system and data analysts for assisting physician staff regarding appropriate clinical documentation and attainment of 5 star rating on all quality metrics.
3. Assists Director of Quality in designating assignments to support staff for the purpose of medical record data reviews and chart retrievals.
4. Responsible, along with Director of Quality, for accountability related to all value-based payer chart reviews, gap closure efforts, quality performance efforts, and outcomes as related to higher functioning quality personnel roles.
5. Responsible, along with Director of Quality, for directly communicating concerns, issues, barriers, and all other value-based payer needs directly with the Director of Quality and payers.
6. Responsible for provision of all provider facing relationships and education, as they relate to quality metrics, value-based support, gap closure, coding education and any other needs as identified by organization and/or Director of Quality.
7. Analyst medical records to identify quality measure gap closure opportunities and trends.
8. Submit supplemental data to appropriate payer portals.
*Clinical quality performance – 10%
1. Attends PHN meetings regarding clinical quality performance.
2. Identifies underlying issues which contribute to gaps in clinical quality performance, working with physician practice staff to close gaps.
3. Assists in guiding quality and population health support staff daily workload and assignments to achieve improvement and to support needs of quality and population health departments.
Other duties – 5%.
1. Performs special projects and additional duties as assigned by the Director of Quality.
Job Type: Full-time
Pay: $55,000.00 - $60,000.00 per year
Benefits:
Schedule:
Experience:
Ability to Commute:
Ability to Relocate:
Work Location: In person
Job Type: Full-time
Pay: $55,000.00 - $60,000.00 per year
Benefits:
Schedule:
Education:
Experience:
Ability to Relocate:
Work Location: Multiple locations
Salary : $55,000 - $60,000
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