Quality Improvement Specialist-Sr

• Performs patient chart reviews to identify opportunities in patient care to satisfy HEDIS measure gaps.
• Maintains systems for storing and tracking HEDIS medical record documentation
• Documents in the Electronic Medical Record.
• Outreaches and requests charts and medical records from other facilities to close gaps in care
• Scans or uploads medical records into payor databases
• Performs patient outreach to schedule Annual Welllness Visits and Follow up appointments to fill gaps in care
• Performs pre-visit evaluations that identify gaps in care for the clinical team and post-visit evaluations that identify gaps in care after the visit.
• Educates staff in the clinics about the metrics and how to close HEDIS gaps in care.
• Identifies, tracks, and follows up on gaps in care that cannot be or were not closed in the clinic.
• Performs medication adherence reviews to identify and mitigate barriers to patients not taking their medication.
• Assists in processing hierarchical condition category attestation forms from payors.
• Identifies opportunities for and works with Senior QISs to implement projects for continuous quality improvement.
• Using evidence-based principles of change management (e.g. DMAIC and other Quality tools) implements projects and processes to improve workflows, processes, and procedures.
• Is responsible for creating and publishing workflows for processes for team to follow
• Is responsible for organizing and maintaining internal files and folders up to date
• Provides in-service training and precepting to Associate Level QI specialists.
• Creates data visualization for HEDIS metrics and medication adherence
• Is responsible for reporting team data at leadership meetings
• Meets with payors representatives to identify and discuss strategies for gap closures
• Leads quality improvement projects, including root cause analyses, related to quality metrics to focus efforts to positively influence results.
• Performs all other duties as assigned.

• Demonstrates the ability to support the mission, vision and patient promise throughout all interactions, The UT Health Way.
• Demonstrate the ability to communicate effectively, written and verbally.
• Demonstrates analytical thinking – this role requires analyzing information and using logic to coordinate work within schedule constraints and handle emergent requirements in a timely manner
• Demonstrates the ability to participate as an integral part of the interdisciplinary healthcare team in providing the highest quality of care to the patient, The UT Health Way.
• Working knowledge of HEDIS measures for which UT Health is responsible under the shared savings programs

EDUCATION:

HS Diploma or GED