Quality Specialist

Position Summary:Positionwillbe responsible forcreating, implementing, andmaintaininga vision and plan for providing improved quality clinical outcomes to patients in the private practice setting, in collaboration with the Senior Leadership team.  We will work with all practices of SCHC on closing care gaps, helpings practices, hospital, and ancillary sites in coordinating patients’ care plan, and work side by side with clinical leadership in creating Quality strategy moving forward. 

Essential Duties and Responsibilities:

• Subject matter expertregardingthe HEDIS product line

• Represent the Clinical Integration product for both client and internal business process meetings

• Collaboration with all affiliate service lines to impact HEDIS and Star ratings and to provide seamless client service

• The position works closely with the Chief Medical Officer to ensure effective clinical, quality, and medical management operational processes and policies that align with targeted quality outcomes and goals for enrollees

• Promotes linkage betweenutilizationmanagement, carecoordinationand quality improvement activities with partnered MSO

• Acts as a role model for clinical staff, promoting education,developmentand adoption of practice transformation with focus on clinical workflow, member satisfaction, improved RAF scoring

• Promotes collaboration while working closely with Director Value Based Care andInnovista, in conjunction withmaintainingappropriate communicationwith CMO and Senior Leadership

• Development, and implementation of Policies and Procedures for Clinical Operations in the clinical office setting 

• Responsible for oversight of clinical training activities and outcomes.

Required Qualifications:  

Education and Training:

• Bachelor's degree in Business, Healthcare Administration, or related field required.

• 3-5 years clinical practice experience or experience improving clinical quality outcomes required.

• Excellent verbal, written, presentation, computer, and interpersonal communication skills. 

• Highly Desired: ICD-10-CM/PCS Coding training and certification  

• 3-5 years clinical practical experience 

•  2-3 years CM, dischargeplanningand/or home health care coordination experience 

• Excellent analytical and problem-solving skills 

• Effective communications, organizational, and interpersonal skills

• Ability to work independently (remote working). 

• Proficiencywith standard corporate software applications, including MS Word, Excel,Outlook,and PowerPoint, as well as some special proprietary applications.  

• Efficient and Effective computer skills including navigating multiple systems and keyboarding