Quality Assurance, Utilization Review, or Case Management

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Senior Quality Specialist Oakland, CA

In collaboration with the clinical lead, provides analytical support and coordinates quality management and performance improvement processes related to quality assessment; performance improvement; clinical documentation review; risk management; infection prevention and control; patient safety; and/or accreditation, regulation and licensing. Under the guidance of a program director or manager, responsible for collecting and researching data, performing data analysis, providing recommendations on data collection/reporting and presenting results.
Essential Functions:
- Partners with clinical quality service lines to identify issues within operations for focus improvement efforts.
- In collaboration with the clinical lead, coordinates on-going, multiple projects (e.g., supporting the clinical service line model).
- Develops timelines and agenda items.
- Helps identify best methods and processes for performance improvement, including developing project plans, facilitating group process and training related to data collection/reporting.
- Support groups through the full rapid improvement cycle.
- Helps identify and recommend actions to correct activities and processes.
- Analyzes, interprets information and makes recommendations on data collection.
- Presents data in a graphical format to support leadership groups and committees strategic planning and decision-making.
- Analyzes and compiles data into spreadsheets and databases.
- Helps identify and communicate alternative solutions to projects as needed.
- Abstracts data using Health Connect; runs reports and communicates results of analysis effectively to key stakeholders.
- Maintains and coordinates audits.
- Assists with developing audit methods to assess performance improvement and to ensure regulatory compliance.
- Based on audit results, creates and presents reports using various systems and databases (e.g., MIDAS focus studies).
- Supports workgroups or committees (e.g., peer review).
- Prepares meeting materials, including agendas and minutes; coordinates conference room logistics; monitors and follows up with action plans).

Secondary Functions:
- Manages on-going multiple quality projects for the East Bay Risk department.
- Conducts needs assessment to plan projects, coordinates and monitors support services/staff, develops timelines, agenda items and presents findings.
- Analyzes, interprets information, and makes recommendations regarding The Joint Commission standards, CME requirements and credentialing/privileges.
- Designs and drafts proposal plans for sponsor approval.
- Monitors project costs, timelines, staffing, space and equipment needs.
- Recommends project strategy.
- Identifies best methods and processes; develops project planning, group process facilitation, training and appropriate information of technology.
- Serves as resource to the Risk and Patient Safety committees.
- Designs communication plans to implement recommendations.
- Identifies and recommends procedures to correct activities and processes.
- Develops and revises standards, policies, procedures and processes, such as improving the link between Quality Outcomes/ Improvement, Risk management, AR&L and Credentialing / Privileges.

Qualifications:

Basic Qualifications:
- Demonstrated ability in managing databases, developing reports and data analysis using Excel and Access (3-5 years).
- Bachelor's degree in business administration, information technology or health care related field OR equivalent experience.
- Demonstrated knowledge of quality improvement; accreditation and licensing.
- Strong problem solving, project management and teamwork skills.
- Advanced skills with Microsoft applications (Word, Excel, Access and Power Point).
- Must be able to work in a Labor-Management partnership.

Preferred Qualifications:
- Significant experience (typically 3-5 years) in health care facility.
- Supervisory experience preferred.
- Current knowledge of The Joint Commission, Title 22 and NCQA required.
- Demonstrated knowledge of adult learning theories.
- Must be PC literate, Microsoft Office applications preferred.
- Valid CA driver's license and personal means of transportation preferred.

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