Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates. We are created and managed by experienced industry professionals in healthcare. As a leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.
Under supervision of the Director of Quality Improvement, the QI Specialist is responsible for developing, organizing, collecting, coordination, preparing and presenting results of quality management studies and projects activities to monitor, evaluate and continuously improve the quality of health care services provided to company members.
Develops, coordinates, collects data, and evaluates clinical and non-clinical quality improvement activities (QIAs) or Performance Improvement Projects (PIPs) for product lines, as a team leader of the Clinical Performance team.
Works collaboratively with management to ensure the activities are meeting goals and are supported by staff.
Receives and processes Quality of Care (QOC) referrals, requests records from appropriate sources.
Reviews and analysis QOC referrals and presents to the medical directors with recommendations.
Coordinates Peer Review process with the Medical Director to ensure QOC issues are dealt with in a timely manner.
Logs, tracks, reports and coordinates QOC determinations with appropriate parties in a timely manner.
Assists in the HEDIS medical record review scheduling project.
Ensures medical record review appointments meet timelines established.
Works with chart review nurses to ensure project loads are adequate, organized, and complete.
Oversees Medical Record Review project. Organizes review of required practitioners, and chart review process.
Organizes data collection. Analysis data, presents findings and recommendations to the Clinical Quality Improvement Committee and regulatory bodies.
Reviews NCQA standards, prepares reports, narratives, graphs, charts, flowcharts, etc. as part of the overall NCQA accreditation preparation.
Participates in member and provider health education outreach with other QI department staff.
Participates in healthcare coalitions and alliances, health fairs and other member and provider educational activities.
Functions in a manner which fosters cohesive teamwork to integrate multidisciplinary procedures, projects and programs within the organization.
Adheres to the practice and principles of confidentiality as outlined in company-wide, department and individual confidentiality and privacy policies and procedures.
Adheres to organizational departmental policies, procedures and protocols.
Knowledge of applicable state, federal and third party quality standards (CMS. NCQA, State).
Excellent verbal and written communication skills
Ability to abide by company policies
Ability to maintain attendance to support required quality and quantity or work
Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
Bachelor’s degree in Nursing, Business Management, Health Administration, Public Health, etc.
2 years Quality Management experience
Medical record auditing experience
QM/QI auditing experience.
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