Role and Responsibility:
Provides general administrative support and duties to the Enterprise Quality Improvement (QI) team
Responsible for interacting with the QI team to develop and implement QI projects, activities and studies (PIPs, QIPs, EDV, etc.)
Coordinate and facilitate QI Department team meetings by scheduling, preparing agendas, taking minutes and coordinating all follow up for next meeting
Assist in the preparations of QI presentations, coordinate the documentation and collaborate schedules of external and internal QI activities and projects
Develop detailed reports of data for analysis of readmissions, complications, sentinel events, grievances and potential quality of care issues for QI department
Research Internet, OnBase, Sharepoint, Streamline and other systems to support QI projects and activities
Retrieve all Clinical Grievances (all products) and Potential Quality of Care, Sentinel events, etc. routed to Enterprise QI and disperse daily to the appropriate QI reviewer
Maintain all QI projects, activities, etc. in a secure manner
Request medical records, information, etc. from providers/facilities to assist in QI investigations
Assist in Quality Enterprise Committee and Market Quality Improvement Committees preparation of reports, documents, etc.
Coordinate dental and vision clinical grievances and assist in process improvement activities related to streamlining these issues
Develop policy and procedures, Quick tools, SOPs for the QI Department
Track and trend potential member risks, sentinel events, and other issues in regards to specific providers, facilities, etc.
Meeting agendas, minutes, document preparation, as needed
Support the QI Department in filing, printing, copying, scanning or applicable information
Demonstrates aptitude for project management by collaborating with internal/external teams
Respond to, forward and return calls from providers, facilities and/or other CareSource staff
Examine and identify ways to improve existing processes/workflows.
Under the direction of the Enterprise QI Manager and Enterprise QI Director is responsible for the coordination of QI activities, reports, studies, etc.
Perform any other job-related instructions, as assigned
Education / Experience:
High School diploma or equivalent is required
Experience in Managed Care preferred
Intermediate skill in Microsoft Excel, Access and Word.
Intermediate skill level with SharePoint
Strong written and verbal communication skills
Ability to work independently and within a team environment
Familiarity of the healthcare field and managed care
Effective listening and critical thinking skills
Strong interpersonal skills
Effective problem solving skills with attention to detail
Ability to develop, prioritize and accomplish goals
Technical writing skills
Ability to coordinate complex projects
Filing and organizational skills
Ability to work with a variety of disciplines and levels of staff across departments
Perform other job related instructions as requested when applicable
Licensure / Certification:
General office environment; may be required to sit/stand for long periods of time.
Ability to lift heavy objects weighing up to fifty pounds
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