Clinical Quality Specialist Jobs

Gain valuable experience in healthcare delivery and payment reform research and development

Manage projects, communicate effectively, and provide excellent customer service

4-6 years of relevant experience

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Contribute to the improvement of healthcare quality and cost reduction in Medicare, Medicaid, and CHIP programs

Work with a team focused on shifting the healthcare system towards value-based care

ICD10 HCS-D certification strongly preferred.

Home Care Home Base software experience a plus!

Strong computer and technology skills required.

About Trinity Health At Home

Degree: Bachelor's preferred. Associate nursing degree considered if successfully demonstrated career progression and meets and exceeds performance expectations.

Ability to consistently demonstrate alignment to the Mission, Vision and Values, Organizational Code of Ethics and adhere to the Compliance Program.

Assist with clinical risk management

Coordinate with Quality Management about room/documentation audits to guide practitioner action plans

Coordinate with CMO, SVP, Network, Director of Clinical & Quality, and/or Manager of Quality to support execution of special clinical projects

2+ years of clinical experience

Voluntary benefits including disability, basic life or pet insurance, etc.

Flexible PTO and Remote First Environment

Strong project management, communication skills, and customer service skills; and

Experience developing and interpreting detailed quality measurement technical specifications and evaluating measure testing, including measure validity and reliability.

Strong analytic and strategic planning skills;

4-6 years of relevant experience.

Deep understanding of operationalizing quality measures, including data collection using claims, clinical registries, and electronic health records;

Patient report outcome measures (PROMS)

Experience with project management tools, spreadsheets, tracking deliverables and issues, meeting deadlines

Patient Safety/Risk Management experience preferred

Monitors for appropriate utilization, implements the policy, and communicates with all external stakeholders including clients, and account managers

Excellent written and verbal communication, and presentation skills

Ability to manage multiple projects simultaneously

5 years’ experience as an RN required, with at least 3 years in a Healthcare Quality role preferred.

Identify departmental training and development opportunities and work collaboratively with peers and Care Management to develop the needed education and/or training

One to three (1 to 3) years of experience in Quality Improvement, Project Management, Case Management or Utilization Review is required

Case Management Certification, such as Certified Case Manager (CCM) through the Commission for Case Management Certification (CCMC), is highly preferred

Assist Management with reporting of case reviews that can be communicated at overall aggregate and individual contributor levels

Provide cross-functional assistance to meet monitoring, accreditation and operational responsibilities to ensure adherence to regulatory requirements

Ensure compliance with adherence to regulatory requirements and identified Standard Operating Procedures (SOPs) through monthly inter-rater reliability monitoring of case reviews

Supports the follow-up of Corrective and Preventive Actions (CAPAs) arising from issue management reports and audits.

Bachelor’s Degree – preferably in a life science, or a combination of education and work experience relevant to the role.

Provides support for Inspection Readiness Activities, vendor qualifications, self-inspection projects and audits.

Prior experience supporting TMF Operations or Clinical Operations in support of TMF activities.

Experience preparing for and/or participating in regulatory inspections.

GCP-related certifications (e.g., SoCRA, SQA-RQAP, etc.).

Possesses and demonstrates working knowledge of equipment in order to ensure a safe environment

Assists other members of the healthcare team to deliver safe, appropriate, and quality patient care

Responds to emergency situations within the scope of their training and performs under the direction of the nurse

Performs vital signs, including use of automatic blood pressure machine as directed by nursing staff

Under the direction of the nurse, provides basic skin care to prevent skin break breakdown and maintain or improve skin integrity

Answers call bells and responds to patient requests within their scope or communicates patient needs to the nurse

Prepares for and hosts external sponsor / IRB audits

Investigates and responds to Corrective and Preventive Action (CAPA) requests in collaboration with Clinical Operations and CQA.

Works with Clinical Operations to obtain evidence of deliverables and facilitates effectiveness checks as needed to ensure CAPA closure.

Reviews monitor letters for issue escalation and quality performance issues

Identifies areas of quality deficiency ensuring escalation to operational leadership and communication with appropriate CQA staff.

Coordinates and facilitates quality review meetings with appropriate CQA staff and operational leadership

HS Diploma or equivalent education/experience

CRC-Certified Risk Adjustment Coder OR CPC-Certified Professional Coder OR AHMA or AAPC Coding Certification (CCS-P, CPC, COC or CPC-P)

1 year recent relevant experience.

Demonstrated written and verbal communications skills to explain sensitive information clearly and professionally.

Equivalent experience will be accepted in lieu of the required degree or diploma.

This position is work from home eligible.

Using clinical knowledge, experience, and problem solving skills to interpret clinical quality data, identify opportunities for improvement, and generate ideas.

At least three years of experience as a registered nurse, preferably in primary care, care management, or outpatient clinics

Prior experience in a quality improvement role or a relevant certification is a plus

Reviewing dashboards of quality metrics, identifying potential issues, and alerting appropriate managers.

Be able to identify and communicate factors that contribute to a good patient experience and outcome.

Reviewing documentation for accuracy, clinical judgment, and adherence to protocols and workflows.

Tuition and continuing education reimbursement

Full suite of voluntary benefits such as identity theft protection and pet insurance

Full medical, dental and vision coverage

Retirement plans to include pension plan and 403(b) matching

Paid time off. Start your employment at UCHealth with PTO in your bank

Employer-paid life and disability insurance with additional buy-up coverage options

Bachelors in Information Management, Healthcare Information, Computing, Mathematics, Statistics or related equivalent field.

Masters in a related field with experience in data analysis as described above is preferred.

Five years of experience in data analysis required

Two years of experience managing financial and clinical databases including case mix files, cost accounting files and severity indexed files required.

Ensures data integrity and security.

Produces dashboards and reports to support facility process improvement efforts

One to two (1-2) years of experience in project management with application preferred.

Robust performance improvement or change management certification with application preferred.

This role is responsible for data management and benchmarking functions along with participation in regulatory, accreditation, and verification activities.

Dept: 8201 Clinical Quality Management

This position will require you to work 40 hours a week, Monday through Friday, 8:00AM-5:00PM and is partial remote eligible.

Two (2) years of experience working with quality systems, Epic or NHSN preferred.

3 years Performance improvement experience including group dynamics, change management, data retrieval, and analysis.

Knowledge, Skills, and Abilities - Required:

5 years Clinical experience in a Pennsylvania hospital. and

Bachelor's Degree Nursing or related field

Master's Degree Nursing or related field

CPHQ - Certified Professional in Healthcare Quality within 2 Years

Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

5+ years acute care nursing or Clinical Documentation Specialist experience required. Critical care and/or ICU experience preferred.Â

Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities

Academic Partnership with the Medical College of Wisconsin

Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics