Value-Based Care | Quality Improvement Specialist (Ma/Lpn/Rn)

The Clinics Quality Improvement Specialist handles coordinating quality management efforts including care gap closure, development, implementation, education, data collection, and analysis. Collaborates with the practices and providers to drive improvement in operational performance and clinical outcome measurements and patient outcomes through quality management.

Job Duties and Responsibilities:

• Remind patients of upcoming preventive services and recommended screenings.
• Facilitate a collaborative approach with the healthcare team to identify and close care gaps.
• Perform chart abstraction of medical records and diagnostic imaging to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Identify documentation improvement opportunities for provider education.
• Request and review medical records for data collection, data entry, and quality monitoring.
• Collaborate with leadership, providers, and staff to identify trends and strategies for improvement.
• Navigate Electronic Medical Records (EMR) systems to obtain medical records that support HEDIS measures.
• Foster a team approach with patients, families, and healthcare teams to coordinate services.
• Serve as a resource for evidence-based practices and clinical guidelines.
• Work collaboratively with physicians and staff to provide improved care quality while reducing unnecessary tests, procedures, and costs.
• Analyze data metrics to determine patient healthcare, educational, and psychosocial needs.
• Facilitate care for high-risk patients using appropriate physician services and community support.
• Participate in patient outreach initiatives, health fairs, and promotions.
• Submit files and documentation for quality assurance and review purposes.
• Perform other related duties as assigned.

Job Requirements:

Required Education:

• High school diploma or equivalent required
• Completion of a Medical Assistant program preferred

Required Licenses and/or Certifications:

• Medical Assistant, Licensed Practical Nurse (LPN), or Registered Nurse (RN)
• Basic Life Support (BLS) certification

Required Work Experience:

• Minimum of one year of experience in urgent care, primary care physician practice setting, and/or direct patient care.
• Must have experience working with EPIC Electronic Medical Records (EMR) software as a user of knowledge of healthcare terms, conditions, roles, and basic care principles.

Required Knowledge, Skills, and Abilities:

• Effective organizational skills with the ability to maintain accurate records.
• Knowledge of medical terminology and healthcare systems.
• Proficiency in using electronic health records software.
• Ability to analyze and present information effectively, respond to questions from various stakeholders, and apply logical thinking to solve problems.
• Computer proficiency in Microsoft Outlook, Word, PowerPoint, Excel, health IT programs, and web-based databases.

Preferred Qualifications:

• Experience with health IT systems and data reports.
• Previous experience with mobilizing community resources, navigating patients through the healthcare continuum, and working with disparate populations preferred.
• Knowledge of primary care ambulatory practice workflows, including front desk, clinical staff and provider workflows preferred
• Knowledge of HEDIS measures, MIPS, and statistics/data management.
• Ability to speak a second language is preferred.
• Statistics and data management knowledge preferred

Functional Demands:

Population(s) Served:

Serves neonatal, pediatric, adolescent, adult, and geriatric populations, including individuals of all genders, races, ethnicities, and backgrounds.

Physical Demands:

Requires prolonged sitting, extensive computer use, and repetitive hand/wrist motions. Visual and manual dexterity required.

Environmental Conditions:

Typically works in an office environment. Weekday hours, with potential for some remote work depending on the schedule.

Organizational Expectations:

• Promotes a positive and professional representation of the organization.
• Adheres to a culture of safety for patients and staff through proper identification and prevention.
• Maintains competency and knowledge of current standards and participates in quality improvement activities.
• Complies with organizational policies, protocols, and confidentiality regulations.