QI Specialist

Job Description

Title: QI Specialist I

Duration: 3 months (Right to Hire)

Location: Springfield, IL

Responsibilities:

·Mon to Fri 8am to 5pm (some flexibility)

·Manager said there is a possibility of FTE

·Interviews will phone be first and then face to face

·This position is for our QI Accreditation team. The Accreditation Specialist is a contributor to one or more critical Quality functions.

·These functions include, but are not be limited to: Quality Reporting, NCQA Compliance, Performance Improvement Projects, and Regulatory Quality Improvement Compliance.

·Responsible for developing, organizing, collecting, coordinating, preparing and presenting results of quality improvement studies and projects activities to monitor, evaluate and continuously improve the quality of healthcare services provided to member.

Essential Functions:

·Participates in NCQA accreditation and regulatory audit preparedness and maintains activities including preparing reports, narratives, graphs, charts, etc. as needed for external audits and surveys.

·Participates in and facilitates quality improvement program committees, as assigned, including preparing materials, minutes and tracking action items for committee review.

·Develops and maintains Quality Improvement department policies and procedures, materials and reports in accordance with State, Federal, and NCQA requirements. State Plan / Department Specific Duties and Responsibilities

·Performs audits of materials and records to demonstrate compliance with accrediting and regulatory requirements, and to identify opportunities for improvement.

·Collaborates with the Quality Improvement department staff in the development of quality improvement studies, initiatives and projects to improve the health care of members.

·Plans and coordinates the collection, evaluation and dissemination of quality improvement data for quality initiatives, studies and projects to comply with regulatory requirements and accreditation standards.

·Prepares reports and analyses to evaluate performance with standards from a variety of sources such as and not limited to: materials, documents, member files, policies, and/or reports.

·Performs with qualitative and quantitative analysis to identify significant and problematic clinical or process issues and concerns, development of improvement plans and measurement to assess impact of actions.

Knowledge/Skills/Abilities:

·Proficiency with PC-based systems, including Microsoft Office applications

·Excellent verbal and written communication skills

·Ability to manage and motivate one's own performance and perform quality work in an exemplary manner, holding one's self accountable to those tasks which they're assigned

·Skilled in handling multiple tasks at once, and pivoting to prioritized tasks quickly

·Ability to abide by policies

·Ability to maintain attendance to support required quality and quantity of work

·Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

·Ability to establish and maintain positive and effective work relationships with co-workers, clients, members, providers and customers

Required Education:

·Bachelor's Degree or equivalent work experience

Required Experience:

·0-2 years’ experience in Quality Improvement.

·0-2 years’ experience in managed care or healthcare industry.

·Experience with policy writing, regulatory requirement interpretation, and/or compliance background.

·Experience with qualitative or quantitative projects/analysis.

If you are not interested in looking at new opportunities at this time I fully understand. I would in that case be appreciative of any referrals you could provide from your network of friends and colleagues in the industry. We do offer a referral bonus that I’d be happy to extend to you if they turn out to be a great fit for my client.

Qualifications

Additional Information

Kind Regards

Sumit Agarwal

732-902-2125