Quality Review Coordinator II (North Carolina, Full Time Remote)

  • Alliance Health
  • Apr 20, 2022
Full time Quality

Job Description

This position is responsible for the evaluation of services delivered to consumers and agency processes to ensure that services delivered are consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations.  This position works with staff, consumers, providers and other stakeholders to evaluate the entire system of health, behavioral health, and I/DD delivery as determined by DMH/DD/SAS, DMA, DHHS, CMS, accrediting bodies and other regulatory entities.  Develops, implements, and conducts statistical analyses of projects, studies, and evaluations designed to improve the quality of services and internal processes.  Applies statistical analysis to quality reviews of internal processes and external information to determine if trends/patterns are impacting service/system quality, and then implement interventions aimed at addressing these trends/patterns with the outcome of services delivered to consumers at the highest degree of quality. 

This position is fulltime remote. Some travel to onsite meetings may be required. 

Duties and Responsibilities

  • Assumes lead for the development and design of multiple Quality Improvement Projects (QIPs) based on sound and valid research methods and statistical techniques as per US Department of Health & Human Services, Centers for Medicare & Medicaid Services (CMS) guidelines for performance improvement projects. QIPs must include 10 elements of a sound, high quality research study; including sufficient probability sampling, measurement of baseline data, sophisticated data analysis, implementation of improvement activities, interpretation of results, institution of a control (quality assurance) system to ensure improvement continues, and a thorough barrier analysis if improvements are not achieved;
  • Performs all aspects of data analysis, preparing accurate reports documenting findings, and ensuring adequate documentation and methodology to support findings and recommendations in line with CMS guidelines for performance improvement projects and focused studies. Guidelines require sophisticated analysis of initial and repeat measures, root cause of problem, realistic targets for measures, and analysis of whether intervention successfully resolved problem. Additionally, analyses may include sophisticated calculations of statistical significance and statistical hypothesis testing;
  • Independently designs and implements research evaluations of shorter-term and focused studies, collaborating with a process improvement team, that address immediate concerns, identifies root causes of concerns, implements solutions, writes brief summary of findings/recommendations, and institutes a control (quality assurance) system for the unit performing the work to ensure improvement continues; and analyzes impact of system on sustaining improvement (in adherence to CMS guidelines for focused studies);
  • Participates in internal committees as a quality improvement and research/statistical analysis subject matter expert; creates and delivers presentations that meet professional, ethical, and analytic standards for clarity and completeness; tracks implementation of solutions; and creates quality assurance systems to effectively sustain improvement;
  • Leads other evaluation/research projects as determined by Supervisor;
  • Creates professional charts, data reports following the sound and rigorous standards for writing scientific reports outlined in the American Psychological Association (APA) Publication Manual, and presentations related to assigned data/evaluation/research projects;
  • Develops and maintains professional and positive working relationships with all Alliance departments, contracted network providers, and consumers/family members to fulfill the mission, vision, and goals of the Quality Management Department, in order to successfully manage cross-functional process improvement teams;
  • Serves as process improvement team lead by defining problems, assembling team of experts, measuring baseline data, analyzing root cause of problem, facilitating process to identify solution, and creating a quality assurance system for the unit performing the work to sustain improvement, and analyzing the impact of the systems on maintaining improvement related to quality management accreditation standards;
  • Assists in developing and delivering instructional materials and providing technical assistance related to evaluation studies, quality reviews, data analysis, and reporting, as requested;
  • Assists in the development of MCO standards for service monitoring, quality improvement, and evaluation of the delivery of services to consumers and families;
  • Serves as team lead for chart or clinical reviews of consumer information in order to conduct analysis of program effectiveness or to identify opportunities for process or quality improvement;

  • Other related duties as assigned 

Required 

Bachelor’s degree in sociology, psychology, or related field, including coursework in statistics, research methodology, computer science, continuous improvement and/or other coursework directly related to the work to be performed, and two years of progressively responsible experience in gathering, editing, and analyzing data for social and economic research, preferably including experience in the particular program area; or an equivalent combination of education and experience.

Five years of experience in the field of quality management/continuous quality improvement preferred

Additional Training Preferred:

Lean, Six Sigma, Project Management, or related certification is preferred; 

Experience in any of the following areas would be valuable for this employee:  Public speaking, mediation and/or problem resolution, group facilitation, advocacy, regulations compliance and project management.

Knowledge and Skills

  • A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance from the Quality Improvement Manager and/or Director of Quality Management.
  • exceptional interpersonal skills, excellent teambuilding skills, and highly effective communication ability are required.
  • Problem solving and conflict resolution skills required
  • Strong written, documentation, and analytical skills are required.
  • Ability to apply statistical principles and valid research methods in the evaluation of problems, along with conceptual and organizational skills to abstract the data.
  • Some knowledge of state and federal rules, requirements and practices related to the service continuum in North Carolina is imperative.
  • Some knowledge of best and promising practices for behavioral health and/or intellectual/developmental disabilities along with
  • Proficiency advanced functions of Microsoft Office Excel are required.
  • Advanced skills in Word, PowerPoint, and Statistical Analysis are preferred.
  • Some travel required.

Salary Range

$48,420.27 - $83,354.24

URL

https://recruiting.ultipro.com/ALL1034ABHC/JobBoard/ad28382f-2fcd-4cbb-bb18-24dd71b05bce/OpportunityDetail?opportunityId=6d69d9c1-4c03-40d3-97c7-bfe7bcabe8f5

Salary

$48,420.27 - $83,354.24