Summary: Under the supervision of the Senior Director, Quality Performance Management, the Quality Improvement (QI) Specialist supports the organization’s quality performance and management platform across care management/care transition programs, other community-based innovative programs and service offerings. As a network, CBC needs to identify gaps in care, referrals, hospitalizations, social determinants of health, diagnoses, medications and other critical data elements that will inform CBC on how best to measure network provider quality care and performance. The Quality Improvement Specialist is responsible for utilizing data to provide oversight and reporting for CBC’s program to support adherence to compliance and quality performance standards outlined by CBC and regulatory entities.
- Assists the Senior Director, Quality Performance Management in reviewing initiative requirements for compliance.
- Participates on meetings with CBC and Managed Care Organizations and or other regulatory entities.
- Draft quality assurance policies and procedures based on contractual guidelines and best practices.
- Interpret, implement and evaluate adequacy of quality assurance/improvement standards.
- Manage tasks related to extracting, aggregating and presenting data for the purpose of measuring performance across network providers.
- Build, prepare, and produce routine and non-routine performance reports derived from various data sources.
- Make recommendations on program improvement based on performance measures, inclusive of HEDIS/QARR.
- Coordinate and support on-site audits conducted by external providers.
- Document internal audits and other quality performance management activities.
- Investigate member complaints and non-conformance issues.
- Develop and facilitate webex and in-person trainings to assist network provider agencies in maintaining quality performance standards and outcome measures.
- Supports ongoing compliance with quality and regulatory requirements.
- Draft Performance Improvement Plans to network provider agencies and participate on calls with agency leadership to develop a plan for improvement.
- Facilitate and support the Senior Director, Quality Performance Management with conducting site visits to network provider agencies.
- Performs other related duties, as assigned.
- Contribute to the field through publications, presentations, and collaborations with service providers, researchers and others;
- Superior communication and writing skills.
- Advance Knowledge of Microsoft office applications, including Excel.
- Experience with Tableau or other data visualization software.
- Experience serving or developing systems who serve persons with chronic health conditions, behavioral health conditions, persons experiencing homelessness, and persons with Medicaid.
- Ability to manage multiple projects and ask for help when needed.
- Ability to participate on a team to accomplish tasks.
- Ability to work with all stakeholders: members, network, families, and government staff in a caring and respectful manner, and with due understanding of and consideration for cultural differences.
- Strong customer service skills and the ability to analyze data to resolve provider and insurance service issues.
- Flexibility and willingness to learn new knowledge and skills.
This position may require some travel throughout the five boroughs of New York City.
Comprehensive benefits package provided.
Minimum Education Required