Clinical Quality Improvement Specialist

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Empower. Unite. Care.

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Under the direct supervision of the MLTC Clinical Quality Manager, the Clinical Quality Improvement Specialist is responsible to review the Uniform Assessment System-NY (UAS-NY) assessments performed by the Assessment Nurses and UAS-NY vendors, ensuring quality and accuracy on documentation and compliance with

• Review clinical documentation in order to ensure that all components of the UAS assessment meets quality standards and accuracy following MetroPlusHealth policies and NYS regulations
• Compare UAS and Tasking Tool to ensure correlation
• Upload the UAS to Lenavi and Develop Task Based tool for members
• Assist Assessment Registered Nurses, as needed, to determine areas that require immediate remediation and assist in resolving inconsistencies
• Prepare various reports and correspondences as well as provide summary reports to highlight key findings for implementation of performance improvement plans
• Maintain a tracking tool that will log unacceptable/inconsistent errors observed during quality reviews
• Communicate inconsistences/identified changes to Assessment Nurses and vendors
• Work with management team to identify areas of continuing education for Assessment Nurses and vendors including MetroPlusHealth policies & procedures for UAS and Tasking Tool assessments
• Assess current quality metrics and identify areas for quality improvement including identification of inter-rater reliability scales and examination of intra-rater reliability upon analysis of the UAS-NY data
• Provide feedback to the management team regarding Assessment Nurse documentation
• Prepare technical guides on Assessment Nurse documentation expectations and improvement
• Assist with special projects as assigned to meet departmental goals and policies
• Oversee vendor dashboards for quality initiatives
• Report weekly to management on UAS reviews
• Other duties as assigned

• Bachelor's Degree from an accredited institution in Nursing or related health care field required
• 2 years of experience in medical records review, claims processing, or utilization and case management in a clinical practice or managed care organization
• Experience analyzing various types of data and processes in a versatile manner including ability to present findings and make recommendations
• Experience with a corporate email system (Microsoft Outlook) including using and sharing calendar rights, Microsoft Word, and electronic Patient Health Information (PHI) database usage (medical records database)
• Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables, calculate data using functions and formulas and create/use PivotTables for analyzing data
• Proficiency with healthcare terminology such as ICD-10 codes and medical abbreviations
  

Licensure and/or Certification Required

• Active, unrestricted NYS Registered Nurse (RN) license
• State registration with UAS for long-term care in NY State (training to be completed during employment)

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication