Quality Improvement Specialist (Hybrid)

$77,200 - $96,500/Yr

Visiting Nurse Service of New York - New York, NY

Full-time

New York, NY

Ambulatory Health Care Services

About the position

The Quality Improvement Specialist plays a crucial role in enhancing the quality of care and performance management within the Health Plan. This position involves conducting and coordinating quality activities, analyzing data to identify improvement opportunities, and ensuring compliance with regulatory requirements. The specialist will work collaboratively with clinical management and various committees to develop and implement quality improvement initiatives that align with organizational goals and improve member satisfaction.

Responsibilities

• Conducts, coordinates, and monitors quality activities and initiatives for one or more products of the Health Plan.
• Maintains, monitors, and develops strategies for the evaluation of member and/or patient care services.
• Analyzes findings and recommends performance improvement initiatives and/or corrective actions.
• Identifies performance and process improvement opportunities to improve HEDIS/QARR, Star ratings, and Incentive programs.
• Assists management with ensuring compliance with regulatory requirements for all products.
• Develops performance measures, designs data collection instruments, and conducts quality, compliance, and utilization reviews.
• Ensures Quality Improvement programs are aligned with CMS Triple Aim framework.
• Collects and analyzes data, identifies trends, writes reports, and presents findings to appropriate committees, managers, and/or staff.
• Prepares, coordinates, and participates in QM Committees and subcommittees as directed.
• Participates in the coordination, review, and approval of policies and procedures for VNS Health Plans and its delegated entities.
• Identifies gaps and recommends creation of new policies.
• Serves as a resource and provides expertise and assistance on quality improvement projects.
• Collaborates with clinical management to identify, develop, and implement quality improvement standards and criteria.
• Evaluates effectiveness of standards and recommends changes, as needed.
• Assists with analysis of member satisfaction surveys and audits.
• Collaborates with Health plan staff to develop initiatives and action plans to improve member satisfaction.
• Keeps informed of the latest internal and external issues and trends in utilization and quality management.
• Participates in the development and implementation of quality projects and initiatives across all product lines.
• Participates in the preparation for and assists with site visits of outside surveyors/regulators for regulatory compliance and accreditation.
• Participates in special projects and performs other duties as assigned.

Requirements

• Bachelor's Degree in Healthcare Administration, Public Health, Business or other related healthcare field or equivalent work experience required.
• Minimum of three years quality improvement experience in a health plan or healthcare setting required.
• Excellent oral, written, and interpersonal communication skills, including group facilitation skills required.
• License and current registration to practice as a registered professional nurse in New York State preferred.
• Current registration to practice as a Licensed Social Worker in New York State preferred.
• Master's Degree preferred.
• Demonstrated leadership experience preferred.
• Knowledge of basic Performance Improvement tools and methodologies preferred.

Nice-to-haves

• Master's Degree preferred.
• Demonstrated leadership experience preferred.
• Knowledge of basic Performance Improvement tools and methodologies preferred.

Benefits

• Competitive salary range of $77,200.00 - $96,500.00 annually.