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Quality Specialist

Job Description

Quality Improvement Specialist


Summary Description

Plans, develops and monitors the internal quality program for all KEPRO activities related to assigned contracts.  Performs quality record reviews on review staff.  Prepares all quality relate reports.  Identifies quality training needs of staff and coordinates with Corporate Training Team relative to those needs. 


Accountabilities

  • Oversees and facilitates all Quality Improvement (QI) activities for assigned contracts.
  • Maintains IQC databases and/or other required documentation to measure quality performance. Modifies data capture as necessary to reflect changes in contract requirements.
  • Develops Tools to be utilized in measuring staff performance measurement. (Accuracy & Inter-rater Reliability) and other QI studies. Prepares reports and documents as indicated/required.
  • Coordinates with the Operational Leadership and the Medical Director to monitor results for physician reviewers. Identifies training needs and coordinates with Corporate Training Team.
  • Identifies training needs and coordinates with the Corporate Training Team in developing educational programs for the contract review staff.
  • Develops or assists in developing tools to measure effectiveness indicators and outcome measurements to determine whether and to what extent the training effort produces the results desired to the participants.
  • Analyzes quality review activities within the assigned contract. Present findings, conclusions and recommendations to Operational Leadership, and the Medical Director.  Identifies opportunities for improvement and recommends changes to record review processes as needed.
  • Develops standardized Quality Management Reporting tool to be utilized in providing quality information back to the client and internal staff. Reviews completed reports for measurement accuracy, action plans if necessary and ongoing plans, prior to being sent out to clients.  . 
  • Promotes a culture of quality performance and quality improvement through out the organization.
  • Develop tools to measure Gold Standard monitoring for reviewer activities. Work with KePRO Corporate quality team to develop tool to be used that will measure IRR.  Analyze outcome reports and identify training needs and coordinate with Corporate Training Team.  Ongoing monitoring to assess effectiveness of training.
  • Develops, coordinates and monitors the customer survey project performed four times per year, Analyzes the outcomes and identifies areas of improvement and works with the Operational Leadership, and the Medical Director and coordinates with the Corporate Training Team to develop training modules for staff to improve results
  • Assists in ongoing compliance with Federal, State and national accreditation standards/regulations.
  • Utilizes quality improvement methods, tools and techniques.
  • Assists with other duties as assigned.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time


Qualifications

  • Active RN, LPN licensed health professional
  • Bachelor’s degree in related discipline or equivalent combination of experience and education.

Skills, Knowledge Abilities

  • Ability to communicate effectively (verbal and written) persons of diverse backgrounds and educational levels.
  • Excellent organization and interpersonal skills required.
  • Ability to prioritize and manage multiple assignments and adjust to changing priorities.
  • Skilled in working with others in a team environment.
  • Must be proficient in MS Office applications (Word, Excel, PowerPoint, and Access).
  • Proven skills using QI tools, methods and techniques such as:
  • Spreadsheet charting and graphing (Essential)
  • Knowledge of NCQA and URAC (Preferred)
  • Knowledge of InterQual (Preferred)
  • Knowledge and use of QI survey tools (Preferred)
  • Strong facilitation and presentation skills desirable.

Experience

  • Experience in quality assurance/quality improvement, preferred.
  • Two (2) years relevant experience including designing, developing and delivering educational sessions.
  • Experience assisting in developing and monitoring internal performance indicators.
  • Recent clinical experience preferred.

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel.


Equal Opportunity Employer

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

Job Requirements

See job description

Job Snapshot

Location US-VA-Richmond
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

KEPRO

Evolving intelligence with timeless values.Since 1985, KEPRO has helped over 1 billion members lead healthier lives through clinical expertise, integrity and compassion. Our values are promises we keep every day. And why we keep growing with our clients. Learn More

Contact Information

US-VA-Richmond
Snapshot
KEPRO
Company:
US-VA-Richmond
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

Quality Improvement Specialist


Summary Description

Plans, develops and monitors the internal quality program for all KEPRO activities related to assigned contracts.  Performs quality record reviews on review staff.  Prepares all quality relate reports.  Identifies quality training needs of staff and coordinates with Corporate Training Team relative to those needs. 


Accountabilities

  • Oversees and facilitates all Quality Improvement (QI) activities for assigned contracts.
  • Maintains IQC databases and/or other required documentation to measure quality performance. Modifies data capture as necessary to reflect changes in contract requirements.
  • Develops Tools to be utilized in measuring staff performance measurement. (Accuracy & Inter-rater Reliability) and other QI studies. Prepares reports and documents as indicated/required.
  • Coordinates with the Operational Leadership and the Medical Director to monitor results for physician reviewers. Identifies training needs and coordinates with Corporate Training Team.
  • Identifies training needs and coordinates with the Corporate Training Team in developing educational programs for the contract review staff.
  • Develops or assists in developing tools to measure effectiveness indicators and outcome measurements to determine whether and to what extent the training effort produces the results desired to the participants.
  • Analyzes quality review activities within the assigned contract. Present findings, conclusions and recommendations to Operational Leadership, and the Medical Director.  Identifies opportunities for improvement and recommends changes to record review processes as needed.
  • Develops standardized Quality Management Reporting tool to be utilized in providing quality information back to the client and internal staff. Reviews completed reports for measurement accuracy, action plans if necessary and ongoing plans, prior to being sent out to clients.  . 
  • Promotes a culture of quality performance and quality improvement through out the organization.
  • Develop tools to measure Gold Standard monitoring for reviewer activities. Work with KePRO Corporate quality team to develop tool to be used that will measure IRR.  Analyze outcome reports and identify training needs and coordinate with Corporate Training Team.  Ongoing monitoring to assess effectiveness of training.
  • Develops, coordinates and monitors the customer survey project performed four times per year, Analyzes the outcomes and identifies areas of improvement and works with the Operational Leadership, and the Medical Director and coordinates with the Corporate Training Team to develop training modules for staff to improve results
  • Assists in ongoing compliance with Federal, State and national accreditation standards/regulations.
  • Utilizes quality improvement methods, tools and techniques.
  • Assists with other duties as assigned.

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time


Qualifications

  • Active RN, LPN licensed health professional
  • Bachelor’s degree in related discipline or equivalent combination of experience and education.

Skills, Knowledge Abilities

  • Ability to communicate effectively (verbal and written) persons of diverse backgrounds and educational levels.
  • Excellent organization and interpersonal skills required.
  • Ability to prioritize and manage multiple assignments and adjust to changing priorities.
  • Skilled in working with others in a team environment.
  • Must be proficient in MS Office applications (Word, Excel, PowerPoint, and Access).
  • Proven skills using QI tools, methods and techniques such as:
  • Spreadsheet charting and graphing (Essential)
  • Knowledge of NCQA and URAC (Preferred)
  • Knowledge of InterQual (Preferred)
  • Knowledge and use of QI survey tools (Preferred)
  • Strong facilitation and presentation skills desirable.

Experience

  • Experience in quality assurance/quality improvement, preferred.
  • Two (2) years relevant experience including designing, developing and delivering educational sessions.
  • Experience assisting in developing and monitoring internal performance indicators.
  • Recent clinical experience preferred.

Mental and Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel.


Equal Opportunity Employer

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.

Job Requirements

See job description

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