Quality Reviewer

Essential Functions/Responsibilities:

Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.

% of Time

(annually)

Operations:

• Performs quality review of service encounters to ensure achievement of quality and customer service goals, and adherence to the policies and procedures of the call center. This may include service observing, review of documentation and call recordings and other quality review tools.

• Delivers programs offered by UnityPoint Health in an accurate and timely manner up to 50% of time including but not limited to triage, post discharge calls, provider after hour calls, provider and service referral, health education, Rx renewal and special projects as needed.

• Responsible for communicating and documenting results of quality review and analysis to staff and leaders.

• Delivers constructive coaching sessions with confidence and in a professional, timely, clear and effective manner.

• Be self-directed and proactive in identifying needs for developing and implementing programs or performance improvement activities.

• Provides feedback to assist in the creation of performance improvement goals and the development of training programs.

• Participates in quality assurance and risk mitigation activities as assigned.

• Ability to effectively present information one on one and in groups.

• Must be able to work independently, appropriately prioritize work activities and use time efficiently to ensure duties are completed per policy and protocol.

• Maintains strict confidentiality of all employee and customer information.

• Maintains regular and consistent attendance at work.

• Must be able to demonstrate and promote a positive team-oriented environment.

• Must be able to work well under pressure and or stressful conditions.

• Must possess the ability to manage change, delays, or unexpected events appropriately.

• Behave in a manner consistent with all Corporate Policies and Procedures.

• Perform all other duties as assigned.

Strategic Planning

• Assists in the development of policy/procedure and guidelines for safe, efficient operation of the department.

• Recommends short and long term strategies to meet the call center goals for service and clinical support. Assists with the achievement of objectives and necessary modifications for attainment of goals.

Leadership:

• Exhibits discretion and sound judgement in all aspects of the job.

• Represents UnityPoint Clinics in a professional manner. Promotes positive interpersonal relations and serves as a role model within the department and with UnityPoint Clinic personnel.
• Creates an environment that promotes staff empowerment.
• Displays creativity and innovation when making recommendations for improvement in the delivery of services to the customer
• Demonstrates the ability to be fair and impartial while maintaining a professional relationship.

• Communicate with leadership team regularly to review service issues and opportunities for improvement to ensure the delivery of high quality service to all internal and external customers.

• Responsible for creating a culture of collaboration innovation, learning, teamwork and professional practice, consistent with the mission, vision and values of UPH.

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

• Demonstrates ability to meet business needs of department with regular, reliable attendance.

• Employee maintains current licenses and/or certifications required for the position.

• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

• Completes all annual education and competency requirements within the calendar year.

• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

• 
  Clinical quality reviewer will be a graduate of an accredited program for Registered Nurses

• 
  BSN
  

Experience:

• 
  Clinical supervisor will have 3 years clinical nursing experience providing direct patient care or equivalent work experience

• 
  Previous experience in quality review or quality improvement.

License(s)/Certification(s):

Knowledge/Skills/Abilities:

Accountability

Adaptability

Business Acumen

Collaboration

Communication-written & verbal

Decision making

Flexibility

Patient Focused

Interpersonal skills

Leadership skills

Managing priorities/deadlines

Planning and organizing skills

Problem-solving

Professionalism

Project management

Relationship management

Teamwork

Technical aptitude –ability to learn new systems quickly

Other:

Use of usual and customary equipment used to perform essential functions of the position.