Quality Specialist

Essential Functions/Responsibilities:

Essential functions are the duties and responsibilities that are essential to the position (not a task list). Do not include if less than 5% of work time is spent on this duty. Be specific without giving explicit instructions on how to perform the task. Do not include duties that are to be performed in the future. Duties should be action oriented and avoid vague or general statements.

% of Time

(annually)

Quality Improvement

• Partners with regional leaders and Regional Director to ensure implementation of consistent and comprehensive process improvement strategies to ensure high levels of quality performance in accordance with regulatory guidelines and strategic plan goal achievement.

• Collaborates with regional leaders to identify, prioritize and achieve data driven quality improvement strategies that affect company operations, with primary focus on service and process improvement initiatives for clinical metrics and patient experience

• Leads and facilitates process improvement, process developments, and action plans.

• Facilitates local quality and process improvement meetings.

• Facilitates local process improvement teams using standard set of tools/resources.

• Leads through change and adversity, makes the tough call when needed, builds consensus when appropriate, motivates and encourages others.

• Effectively presents information and responds to questions from groups of managers, clients, customers, and the general public. Ability to present data analysis in layman’s terms to ensure breadth of organizational understanding.

• Breaks down problems into smaller components, understands underlying issues, can simplify and process complex issues, understands the difference between critical details and unimportant facts; challenges the status quo, takes risks, and solves problems creatively.

• Skillfully draws out information, opinions and ideas in a group setting. Handles difficult people and ensures everyone has an opportunity to be heard by managing distractions and interruptions. Demonstrates active listening and ability to be open to other viewpoints.

Clinical Analysis

• Completes clinical metric and patient experience drill down in opportunity areas for improvement.

• Reviews and analyzes deep level drill down by utilization of appropriate related reports or subsequent manipulation of data in identified tools to determine critical components for improvement.

Clinical Excellence

• Responsible for the timely completion of quality chart review for clinical documentation.

• Utilization of specified audit process.

• Reviews CTI, Face to Face encounter forms, NOE, and POC for timeliness and accuracy

• Reviews SOC, ROC, Re-certification and Transfer/Discharge OASIS manually for inconsistencies, omissions and errors, logs and tracks corrections

• Assists in quarterly regulatory compliance audits where applicable

• Participate in auditing potentially avoidable events and compliance audits as needed

• Expert in service line rules and regulations for COPs, ACHC Certification, and State licensing.

• Provides “Just in Time” education to team members as needed including audit findings.

• Provides initial orientation education and training to clinical staff regarding SHP, OASIS, HIS, or HQRP documentation accuracy and appropriateness.

Basic UPH Performance Criteria

• Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

• Demonstrates ability to meet business needs of department with regular, reliable attendance.

• Employee maintains current licenses and/or certifications required for the position.

• Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

• Completes all annual education and competency requirements within the calendar year.

• Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

Graduate of State Board approved program for Registered Nurses.

Experience:

License(s)/Certification(s):

Valid driver’s license when driving any vehicle for work-related reasons.

Current license to practice nursing in the applicable state for Registered Nurse.

COS-C or HCS-O certification must be obtained within 12 months of hire date.

Valid Mandatory Reporter course completion by state requirement.

Knowledge/Skills/Abilities:

• 
  Strong interpersonal skills.

• Ability to effectively facilitate a team through change

• Ability to work as a team member.

• Strong computer skills.

• Ability to understand and apply guidelines, policies and procedures.

• Strong organizational and time management skills.

• Ability to critically think and make clinical decisions based on verbal and written communication.

• 
  Formal education and training in QAPI, utilization review, Change Management, Process Mapping, Adaptive Design, or Work-Out™.

• Demonstrated success in leading and sustaining change through health care improvement initiatives, and change leadership using methodologies such as Six Sigma, Baldrige, Lean, Work-Out™, PDSA, and Adaptive Design.

• Demonstrated ability to successfully lead cross-functional teams to achieve sustainable results.

Other:

Use of usual and customary equipment used to perform essential functions of the position.