The Quality Improvement Specialist serves the Gundersen Health Plan and its network providers as a proactive consultant, project manager, and advisor for key strategies in quality, service and efficiency. The QI Specialist uses performance improvement practices and a quality improvement approach along with project planning and management methods to implement changes directed at improvement; measures the extent of improvement achieved; converts data into useable information, facilitates groups and team work and assures that improvement activities are documented and reported. The QI specialist promotes collaboration with internal and external customers. The QI Specialist assists in meeting regulatory standards for CMS, NCQA, OCI, DHS and other regulatory bodies.
Provide strategic consulting and support to the health plan with respect to improvement strategies; project manager for a variety of identified improvement projects based on HEDIS quality measures, Department of Health Services (DHS) contract requirements, including pay for performance measures, and Centers for Medicare and Medicaid Services (CMS) regulations.
Supports organization leadership to meet regulatory standards by demonstrating in-depth knowledge of CMSquality standards, NCQA standards and DHS contract requirements; insures QI activities meet these requirements.
Design/develop short and long-term improvement strategies in support of goals for quality, service and efficiency.
Coordinate quality improvement projects by applying the Continuous Quality Improvement Approach; applies and appropriately uses CQI tools in support of the improvement process and analysis.
Partner with the health plan's Medical Director and Associate Medical Directors, health plan departments, Gundersen Lutheran Medical Center in the development of quality, service and efficiency plans; track progress towards achievement of plans.
Facilitate groups and teams to promote effective and efficient achievement of their QI initiative goals.
Work with Medical Directors/Health Plan Administration/Managers, and other staff to provide advice, facilitation and support related to project management, process improvement and interpretation of a variety of data and outcomes measures. Assures that sound project management and improvement methodology is used. Assures that the impact of the improvement is measured and sustained.
Demonstrate ability to make recommendations and implement quality improvement interventions based on results of projects. Converts data into useable information, and measures the impact of improvement initiatives.
Applies project planning and management to effectively meet outcome, time, and budget parameters.
Assures that quality improvement activities are documented and reported within the organization and externally as appropriate.
Performs other job-related responsibilities as requested.
Scope of the Job Age Specific Population Served Nonage Specific (N/A)
OSHA Category Category III - No employees in this job title have a reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials. Position Qualifications Education and Experience: Required Bachelor's degree in Health Sciences or Health Education or Nursing from an accredited college of nursing, as recognized by the Accreditation Commission for Education in Nursing or Commission on Collegiate Nursing Education. or Business or Healthcare Administration or Health Information Management or Management Engineering
Work Experience: Required 5-7 years progressively responsible experience in areas related to quality or performance improvement or process redesign, management of projects, or change initiatives. Desired 6 months Required work experience, plus previous work experience in a health insurance setting and previous experience working with CMS, NCQA, DHS and HEDIS guidelines. Previous experience with Disease Management and Health Promotion activities. Previous quality improvement experience. Skills: Required Ability to... Computer Systems/Software/Applications excellent computer skills Computer Systems/Software/Applications maintain proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Illustrator, etc.) Communication compose materials such as detailed reports, work-related manuals, publications of limited scope or impact, etc., and/or make presentations outside the immediate work area. Communication demonstrate effective customer service to internal and external customers Comprehension understand complex problems and to collaborate and explore alternative solutions Comprehension demonstrate a detailed understanding of descriptive statistics and comprehension of interpretive statistics. Dept. Specific - Nonpatient Care Lean, PDSA, Six Sigma or other process improvement methodology General - All Positions work independently with minimal supervision General - All Positions and experience with the CQI process and methodology including use of QI tools and QI study design (rapid cycle, PDSA, etc.) General - All Positions project management methodologies and tools General - All Positions statistical designs and analysis General - All Positions work as part of a team Organization organize and monitor multiple projects and files to ensure timely and accurate completion Organization organize thoughts and ideas into understandable terminology.