ECM Quality Assurance Coordinator

INTRODUCTION:

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) committed to the Triple Aim as described by the Institute for Healthcare Improvement. Improving the US health care system requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations, and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.

SUMMARY: 

The Quality Assurance Coordinator will work with the Quality & Contracts Supervisor and ECM Director to deliver a comprehensive training program and Quality Assurance program for the ECM program and staff.

 ESSENTIAL DUTIES AND RESPONSIBILITIES include but are not limited to the following functions:

• Monitor and improve monthly the Quality metrics for all program staff, including but not limited to billing errors, number of encounters, care plan, comprehensive assessment, and authorization compliance.

• Track, manage, document, identify, and report patient data.

• Assist with monthly reporting, such as creating RTF/OTF, SCR, and CLR.

• Ensure member assignment to by health plan to CNHF.

• Distribute and monitor the caseload for all LCM staff.

• Audit exclusions to ensure all required documentation is on file.

• Data entry as needed.

• Work closely with LCM and clinical consultants to ensure coordination and transition of care.

• Monitor health plan portals for reports and hospital notifications and distribute hospital notifications to staff.

• Prepare reports/deliverables for submission to meet Quality requirements, including monthly action plans to LCMs as part of continuous process improvement.

• Participating in monthly health plan meetings and training.

• Participate in Quality Management team planning meetings as requested.

• Utilize a variety of reports to perform QA on all functions within ECM, providing supervisors with the data needed to have constructive feedback sessions with their staff.

• Utilize quality assurance activities to identify opportunities for additional training and/or enhancements to the curriculum and develop training materials

• Coordinates assigned quality and process improvement activities, which may include process improvement projects, quality studies, CQI (continuous quality improvement) process training for staff, prevention program coordination, and care coordination initiatives.

• Conducts quality control reviews and internal audits. Summarizes findings and prepares reports on findings.

• Conducts analyses of data findings for quality and process improvement and assists in report preparation for the Quality & Contracts Supervisor and ECM Director.

• Supports assigned quality activities through comprehensive project management, ensuring that documentation is accurate and timely.

• Review patient healthcare information and records.

• Define the level of care for the tier system.

• Advise staff and other clinical and non-clinical staff on ECM standards and procedures.

• Interacts with nurses, department managers, supervisors, and ECM staff members to provide resource information, resolve ECM-related problems, and identify new opportunities to improve service.

• Perform other duties as assigned.

QUALIFICATION REQUIREMENTS: 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

EDUCATION AND/OR EXPERIENCE: 

• Bachelor’s Degree or MPH, MBA, MHA, or related Master's degree preferred or relevant experience.

• Excellent communication skills, oral & written

• Experience in delivering training preferred

• Experience with Managed Care/Hospital work experience required

• Prior experience performing quality assurance in a healthcare environment

NECESSARY SKILLS: 

• Must have excellent interpersonal skills and empathy towards patients, excellent communication skills, critical thinking skills, the ability to handle stressful situations, the capacity to function independently, have varied clinical experience, and the ability to document meticulously.

• Excellent organizational and prioritization skills.

• Excellent presentation skills

• Ability to manage multiple deadlines in a fast-paced environment.

• Strong problem-solving, group facilitation, and teamwork capabilities.

• Ability to work with and utilize volunteers in a variety of fundraising capacities.

• Active participation in a multi-disciplinary team of professionals and volunteers.

• Ability to maintain integrity by keeping proprietary and sensitive information confidential.

• Ability to respond with sensitivity to people of diverse cultures and various lifestyles.

• Willingness to commit to the philosophy and goals of CNCHC and work as a team.

WORK ENVIRONMENT  

Described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.

CONFIDENTIALITY 

Maintains patient, employee, and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

1. AGREEMENT AND ACCEPTANCE 

2. I HAVE READ THE ABOVE JOB DESCRIPTION AND FULLY UNDERSTAND THE REQUIREMENTS SET FORTH AND WILL PERFORM ALL DUTIES AND RESPONSIBILITIES TO THE BEST OF MY ABILITY.