Department:OH1HP_65500_000 Health Partners - Aco
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we’re committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care
Job Description Details:
Our Quality Management Coordinator is responsible for application of extensive knowledge in physician clinical performance improvement activities. Leadership skills and experience in utilization management, evidence based medicine, care coordination, physician communication, health care benefits and varied reporting of health care and pharmacy benefit plans including home infusion. Individual will be responsible for the development, reporting and driving physician engagement strategies for improving physician care practices based on clinical guidelines and best practice internal and external benchmarks and available claims based data systems. Responsibilities also include clinical outcome analysis, monitoring, reporting and documentation of data collection methods, tools, and outcomes of focused physician quality related studies and/or audits.
- Assists in review and guidance of the pertinent clinical literature and guidelines associated to physician quality improvement initiatives, as well as the development of project of data elements, performance measurements and goals.
- Design and manage quality improvement projects and study methodologies with the responsibility of the collection and analysis of data to assess performance, identify issues impacting optimal performance and recommend actins designed to impact improvement
- Responsible for requesting and reviewing medical records for the purposes of quality concern monitoring, peer review, clinical studies and/or audits associated with compliance and reporting outcomes associated with NCQA and/or other nationally recognized quality guidelines.
- Responsible for designing report requests, managing data collection and report analysis for quality projects and/or quality concerns utilizing Mount Carmel patient data bases, including Advance Plan for Health.
- Accountable for the review, preparation and presentation of medical cases for the Medical Director, Quality and Clinical Integration Committee, Credentials Committee and /or external agency.
- Self-starter who requires minimal supervision with strong leadership skills and health care knowledge required to produce dramatic change processes required for effective performance improvement in physician practice patterns.
- Education: Associate Degree in Nursing required. Bachelors In Nursing preferred.
- Active Ohio Registered Nurse license preferred. In lieu of RN, Quality Management experience and Masters Degree, Quality Management certification, such as CPHQ preferred.
- Minimum of 5-7 years of clinical experience with some in an acute care setting or outpatient clinical setting preferred.
- At least 2 years of previous quality assurance/improvement experience and/or chart review experience preferred. 2-3 years case management experience in an insurance company setting, workers compensation program or utilization management firm preferred.
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.