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SalaryJob Summary: Under the supervision of the Compliance Officer (CO) & Vice President, QPM, the QI Specialist supports CBC’s enterprise-wide quality performance management and improvement platform across CBC’s IPA and programs. The QI Specialist contributes to the design of QI measurement strategies and systems, provides QI guidance and advising to network partners, and provides QI training for CBC staff.
Minimum Education Requirements:
- A bachelor’s degree in Social Work, Psychology, Public Administration, Nursing, Public Health, Public Policy, Business, or a related field.
Essential Duties and Responsibilities
- Strategic Planning
- Works with CO & Vice President, QPM to formulate recommendations on opportunities for improvement based on performance measures (inclusive program and contract-specific measures as well as HEDIS/QARR measures related to closing programmatic gaps in care).
- Supports the planning, implementation, monitoring and evaluating of QI initiatives and interventions.
- Research QI methods, tools and best practices and develop QI supporting materials.
- Policies, Procedures and Standards
- Drafts, maintains and edits quality assurance policies and procedures based on contractual guidelines and best practices.
- Interprets, implements and evaluates adequacy of quality assurance/ improvement standards.
- Drafts practice standards that are developed through the implementation and evaluation of QI initiatives.
- Data Management and Reporting
- Works collaboratively with CBC’s data team to design, review and analyze QI reports and dashboards developed by the data team.
- Reviews and present QI data in various IPA and program network provider and quality meetings.
- Manages tasks related to extracting, aggregating, and presenting data for the purpose of measuring performance across network providers.
- Performance Monitoring
- Interprets, implements, and evaluates adequacy of CBC Quality Improvement standards.
- Supports the QPM team with internal/external audits as needed.
- Collaborates with QPM Specialist and CO & VP, QPM on review of QA/compliance issues to identify QI needs.
- Supports QPM Specialist in making recommendations for programs to improve data quality and compliance with CBC program standards.
- Compliance and Quality Assurance
- Supports network provider agencies with ongoing compliance with quality and regulatory requirements.
- Participates as needed in meetings with Managed Care Organizations and other regulatory entities to analyze performance improvement data and assists QPM Specialist with audits. , requests for records and case conferences.
- Supports QPM Specialist, as needed, in review of incidents, conducts root cause analysis and reports incidents as directed by regulatory entities.
- Leadership and Facilitation
- Co-Chairs the quarterly Network Quality Meeting.
- Develops and facilitates group QI initiatives/activities.
- Works with QPM Specialist to incorporate performance improvement/QI Initiatives (as needed) as part of the Health Home Quality Management Team (QMT) and Children’s QMT meetings.
- Education and Training
- Network Provider Agency Training - Develops and facilitates trainings in collaboration with CBC’s Training Institute, to assist network provider agencies for improving processes, outcomes and member experience.
- CBC Staff Training - Supports Total Quality Management (TQM) across CBC, by providing education and training to CBC program staff that are charged with conducting QA/QI activities, such as case record reviews, incident reporting, policy and procedure development, internal program reports, and PIPs.
- Provides QI coaching and Technical Assistance as needed.
- Reporting/Communications
- Highlights key QI initiatives, meetings and statistical outcomes in CBC’s newsletter, grant applications and other publications as requested.
- Performs other related duties, as assigned.
Experience:
- Minimum of 4 years’ experience with a bachelor’s degree, working with the Behavioral Health population in quality assurance/improvement activities, UR/UM.
- Minimum of 2 years’ experience with a master’s degree, working with the Behavioral Health population in quality assurance/improvement activities, UR/UM.
- Superior communication and writing skills.
- Advance Knowledge of Microsoft office applications, including Excel.
- Experience facilitating and/or participating in QI Initiative utilizing Model for Improvement (PDSA) or similar model to measure improvement.
- Experience with Tableau or other data visualization software.
- Experience serving or developing systems who serve persons with chronic health conditions, behavioral health conditions, persons experiencing homelessness, and persons with Medicaid.
- Ability to manage multiple projects and ask for help when needed.
- Ability to participate on a team to accomplish tasks.
- Ability to work with all stakeholders: members, network, families, and government staff in a caring and respectful manner, and with due understanding of and consideration for cultural differences.
- Strong customer service skills and the ability to analyze data to resolve provider and insurance service issues.
Additional Details:
- Salary Scale: 68,000 – 75,000
- How to Apply: please submit cover letter and resume to hr@cbcare.org
Due to the volume of candidates, we receive, unfortunately, we are unable to respond to every applicant.
Only applicants scheduled for an interview will be contacted.
Job Type: Full-time
Pay: $68,000.00 - $75,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
People with a criminal record are encouraged to apply
Work Location: Hybrid remote in New York, NY 10006
