UnityPoint Health Clinical Quality Specialist in Rock Island, Illinois
The Clinical Quality Specialist is responsible for the review, abstraction, compilation, evaluation, analysis, communication, and reporting of clinical quality measures data. The results and findings are distributed to regulatory agencies and to all levels of organizational leadership, including the Board of Directors, for performance improvement purposes.
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
· Reviews patient records and evaluates the clinical quality of care based on the federal accreditation and regulatory requirements.
· Monitors and analyzes data related to the clinical quality measures identifying opportunities for improvement using analysis and clinical judgment.
· Performs and coordinates the review, abstraction, compilation, evaluation, analysis, and reporting of data for CMS/TJC hospital inpatient and outpatient quality measures
· Serves as the liaison for Premier, Quality Net, and other databases.
· Serves as the backup Administrator for Premier, Quality Net and other databases.
· Ensures reliability and validity of the national quality measure data and able to maintain 90% proficiency in validation scores.
· Serves as a resource to peers, colleagues, management, and medical staff regarding requirements of national quality measures.
· Maintains a current working knowledge relative to state and federal standards and regulatory requirements (i.e., CMS Conditions of Participation, The Joint Commission standards, state hospital licensure, etc.).
· Maintain and evaluate Hospital Acquired Condition work que using clinical judgement and regulatory requirements
· Assists with Clinical Data Abstraction audits.
· Works closely with the Health Information Management, Clinical Informatics, and Coding Departments to verify the accuracy of data.
· Maintains current knowledge of national quality measures and keeps current on all changes related to national quality measure requirements by attending webcasts and other educational programs.
· Other responsibilities as assigned.
Data Analysis & Reporting
· Prepares, analyzes, and presents requested reports regarding process of care and patient outcomes data involving the hospital, physicians, service lines, etc. utilizing Premier, Quality Net or other databases.
· Facilitates timely submission of national quality measure data to Premier and other potential databases to ensure that CMS, TJC, & IHA deadlines are met.
· Aggregates data and maintains database for national quality measure findings.
· Facilitate data analysis and follow-up on all clinical quality process and outcome measures.
· Revises data elements and reporting formats as needed to meet the complex data needs of the hospital.
· Identifies significant patterns, profiles, and trends and maintains appropriate records.
· Facilitates data analysis, trending, reporting, and presentation on individual and departmental statistics.
· Provides feedback related to national quality measure compliance issues to leadership, physicians, and committees.
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.
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Demonstration of UPH Values and Standards of Behaviors
Consistently demonstrates UnityPoint Health’s values in the performance of job duties and responsibilities
· Leverage the skills and abilities of each person to enable great teams.
· Collaborate across departments, facilities, business units and regions.
· Seek to understand and are open to diverse thoughts and perspectives.
Own The Moment:
· Connect with each person treating them with courtesy, compassion, empathy and respect
· Enthusiastically engage in our work.
· Accountable for our individual actions and our team performance.
· Responsible for solving problems regardless of the origin.
· Commit to the best outcomes and highest quality.
· Have a relentless focus on exceeding expectations.
· Believe in sharing our results, learning from our mistakes and celebrating our successes.
· Embrace and promote innovation and transformation.
· Create partnerships that improve care delivery in our communities.
· Have the courage to challenge the status quo.
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.
· Completion of 4-year accredited Bachelor of Science in Nursing, or other related health field or equivalent experience.
· Completion of an accredited Master of Nursing, Master of Public Health or other related health field or equivalent experience
· 3-5 years data abstraction and analysis experience.
· Experience with EPIC or other electronic health record.
· 2-3 years clinical experience
· 4-5 years clinical healthcare experience.
· Knowledge of performance improvement methodologies, CMS Conditions of Participation, Joint Commission standards, ICD-10 codes, CPT codes, and MS-DRG codes.
· Valid driver’s license when driving any vehicle for work-related reasons.
· RN, current Registered Professional Nursing License in the States of Illinois and Iowa
· Working knowledge of computer operations, electronic health records, report writing, database management, excel, and statistical tools.
· Advanced verbal and written communication skills.
· Ability to communicate efficiently and effectively to multiple groups and provide excellent customer service.
· Ability to demonstrate sound judgement and attention to detail.
· Ability to work independently as well as with diverse teams and individuals.
· Critical thinking skills to abstract data based on complex guidelines.
· Willingness to learn new software applications for data analysis, reporting, and monitoring.
· Use of usual and customary equipment used to perform essential functions of the position.
Requisition ID: 2021-90422
Street: 2701 17th St
Name: 6020 UnityPoint Health QC Trinity
Name: Quality Improvement
FLSA Status: Exempt
Scheduled Hours/Shift: Day
External Company URL: http://www.unitypoint.org