Quality Management Specialist

JOB PURPOSE:

The Quality Management Specialist works in conjunction with operational and clinical staff to facilitate Quality Management/Performance Improvement programs. The Quality Management Specialist supports the monitoring activities to ensure quality across CenterLight Healthcare and collaborates with performance improvement initiatives to ensure care delivery and services are provided according to the highest standards of care.

JOB RESPONSIBILITIES: 

• Utilize quality improvement methodologies, such as PDSA, Six-Sigma, Lean, or other standardized quality tools to assist business owners in driving quality improvement initiatives.
• Use sound clinical judgment to identify deviations in clinical standards of care delivery.
• Serve as liaison between the PACE sites, department leaders, medical directors, and Quality.
• Conduct root cause analyses to identify deficiencies and implement evidence-based interventions for Level 2 Incidents.
• Monitor and investigate all potential or identified quality of care incidents and collaborate with appropriate staff to determine the impact and next steps for action. 
• Conduct monthly internal monitoring and audits to identify opportunities for performance improvement.
• Participate on Site/Center preparation and execution of audit readiness by regulatory and accreditation agencies (State and Federal agencies, CMS, NCQA, etc.).
• Collect, summarize, and analyze performance data and identify opportunities for improvement.
• Support Quality committees; facilitate and participate in Quality committees and workgroups
• Investigate and incorporate national best practice interventions to affect greater improvements.
• Draw conclusions from data analysis to initiate and facilitate performance improvement projects.
• Maintain working knowledge of regulatory requirements related to quality for health plan and care delivery products relevant to CenterLight Healthcare.
• Identify and escalate urgent quality and operational matters.
• Conduct, analyze, and report results of quality audits

Weekly Hours: 40

Schedule: 8:30AM - 5:30PM

QUALIFICATIONS:

EDUCATION:

• Bachelor’s degree in Nursing or other related health field required. A Master's Degree is preferred.

EXPERIENCE: 

• 3-5 Years Progressively responsible related work experience including regulatory agency standards and performance improvement initiatives required. 

OTHER REQUIREMENTS:

• Excellent written and oral communication skills. Ability to communicate effectively with people with varying levels of education and at varying levels of the organization
• Ability to work effectively in a fast-paced environment
• Ability to create informative and engaging presentations using PowerPoint or other presentation programs.
• Proficient in other Microsoft Office products including Teams, Word, Excel, and Outlook.
• Ability to utilize other data management systems to pull and analyze information to draw conclusions and recommendations.
• Experience working with a variety of departments both clinical and non-clinical and influencing others to get buy-in regarding quality improvement initiatives

Physical Requirements

Individuals must be able to sustain specific physical requirements essential to the job. This includes, but is not limited to:

• Standing – duration of up to 6 hours a day
• Sitting/Stationary positions – sedentary position for a duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull – up to 50 pounds of equipment, baggage, supplies, and other items used in the job scope using OSHA guidelines, etc.
• Bending/Squatting – have to be able to safely bend or squat to perform the essential functions under the scope of the job.
• Stairs/Steps/Walking/Climbing – must be able to maneuver stairs safely, climb up/down and walk to access work areas.
• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (i.e., typing, use of supplies, equipment, etc.)
• Sight/Visual Requirements – must be able to read documentation, papers, orders, signs, etc., and accurately type/write documentation, etc.
• Audio Hearing and Motor Skills (language) Requirements – must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, one must be able to speak comfortably and clearly with language and motor skills for customers to understand an individual.
• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer:Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max):

Every application is reviewed by our recruitment team. We do not use AI to make hiring decisions or automatically reject applicants. All employment decisions are based on job-related qualifications and applicable employment laws.