Accountable for directing the organization’s quality efforts for clinical operations to meet regulatory requirements and accomplish business objectives, including value/performance-based revenue goals.
Knowledge, skills and abilities:
Ability to work independently, prioritize tasks, problem-solve, and maintain focus on organizational goals. Must have excellent relationship development skills with the ability to work with teams to affect improvement in patient care. Knowledge of community resources. Practical knowledge and understanding of pertinent legislation.
Education, Training and Experience (includes licenses or certifications) required:
- Master’s degree in Health Administration, health discipline, or comparable clinical background in primary healthcare, nursing, or related health profession plus:
- A minimum of three (3) years’ experience in quality improvement or healthcare administration. Must have demonstrated ability to develop and implement policies and procedures.
- Preference given to licensed RN with background in hospice.
- Three (3) years’ experience working in a community primary health care setting.
- Minimum of 1 year of experience with meaningful use reporting required.
- Ability to work independently, prioritize tasks, problem-solve, and maintain focus on organizational goals.
- Advanced computer proficiency in MS Word and Excel, with ability to create and analyze data, and generate reports required Access and other quantitative software program experience highly desired.
- Must have excellent communication skills with the ability to handle and communicate sensitive information.
Principle Duties and Functions:
- Responsible for meeting QAPI regulatory requirements for hospice certification and licensure surveys and maintaining current knowledge related to Medicare Conditions of Participation and the Community Health Accreditation Program’s (CHAP) standard
- Oversee PIPs, including convening and assisting team leader in facilitating meetings, generating minutes, and reporting back to QAPI committee
- Facilitate development of Annual Improvement plans and monitor performance through data collection and reporting
- Facilitate annual evaluation and assessment of the hospice program using NHPCO self-assessment or other identified tool in non-accreditation years and QAPI program using internal self-assessment tool
- Oversee data collection and CMS reporting requirements for hospice (e.g. Hospice Item Set, CAHPs Survey, etc.) and participation in national quality reporting to benchmark performance and monitor trends (e.g. OCS QAPI Snapshot, NHPCO surveys, etc.)
- Provide agency Governing Board QAPI program reports to assist them in fulfilling CMS and CHAP mandated QAPI oversight responsibilities
- Convene and facilitate regular QAPI committee meetings, insuring minutes of each meeting are documented and available to committee members
- Keep leadership informed about agency performance and situations of concern
- Avoid payment reductions on Hospice payments by ensuring that the organization meets Hospice Quality Program Requirements:
- Hospice Item Set (HIS)
- Consumer Assessment of Healthcare Providers & Systems (CAHPS) Survey
- Must develop and maintain thorough understanding and working knowledge of electronic systems:
- CASPER Reporting Application (HIS)
- Hospice Abstraction Reporting Tool (HART)
- NRC Picker – CAHPs Data Submission Portal
- CAHPS Hospice Survey Data Warehouse (RAND)
- Program for Evaluating Payment Patterns Electronic Report (PEPPER) Resource Portal
- Provider Statistical & Reimbursement Report (PS&R) Portal
- Primary Care
- Oregon Medicaid Provider Portal
- ALERT IIS System
- Patient Portal
- PQRS vendor submission portal
- 2016 Physician Quality Reporting System Group Practice Reporting Option (PQRS GPRO).
- Oversee data collection and reporting requirements required for recognized Oregon Patient-Centered Primary Care Homes and obtaining supplemental payments from Medicaid programs
- Achieve financial objectives by coordinating facets of commercial and governmental healthcare payer’s value/performance-based programs.
- Maintain strong understanding and knowledge of all commercial and governmental value/performance-based payment model regulations and assist leadership with aligning the organization’s quality strategy accordingly
- Communicate quality and/or compliance requirements to the organization’s leadership and apply appropriate standards to the strategic planning process
- Serve as the primary contact with commercial and government agencies responsible for the development of quality metrics
- Turn the organization’s leadership quality performance strategies into an executable action plan
- Implement clinical operation workflows that supports all the documentation requirements necessary to support organizational quality measures and participate in commercial and government value-based programs. Develop workflows with assistance from clinical staff to get provider buy-in. Stay up-to-date about changing program requirements and proactively implement necessary changes to clinical operation workflows
- Participate in setting measurable performance thresholds for all quality indicators within clinical operations to evaluate workflow effectiveness and to determine the infrastructure required to support quality standard needs
- Identify opportunities to collaborate and develop clinical integration with other healthcare clinics/delivery systems (OCHIN, ALERT IIS) to reduce quality program costs while achieving outcomes
- Prepares quality performance reports to provide to the organization’s leadership
- Oversee data gathering for ongoing quality assessment including but not limited to clinical indicators and outcomes, internal process measures, adverse events and complaints, employee/patient/family satisfaction in partnership with others as applicable. (For example, hospice pain assessment chart review, hospice clinical audits, medication reconciliation, goals of care/POLST documentation.)
- Develop and administer data collection and survey tools
- Create reports and analyze data
- Make recommendations to QAPI committee for using results and initiating performance improvement strategies and project teams (PIPs)
- Consult with staff from departments to assess and assist with data and performance improvement needs
- Provide and/or facilitate staff communication of performance results
- Other related duties as assigned
Equal Opportunity Employer