Utilizes internal and external sources to collect, verify, and abstract moderately complex data related to quality of patient care. Assists with the development of appropriate data reporting structures to support quality reviews for new initiatives.
- Works closely with the CMO to identify quality measures associated with initiatives and programs including but not limited to Physician Quality Reporting System, Healthcare Effectiveness Data and Information Set (HEDIS), Quality Resource and Utilization Resource Reports and the Value Modifier Program, Medicare Shared Savings Program, Comprehensive Primary Care Plus, and Medicare Access & Children's Health Insurance Program Reauthorization Act of 2015 (MACRA) Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Maintains and communicates a working knowledge of healthcare related organizations including Centers for Medicare and Medicaid Services, Centers for Medicare and Medicaid Innovation Center, and regional quality improvement organizations.
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20 |
Applies acquired skills and experience to identify statistical trends and issues in patient care and services. Contributes to moderately-complex projects in assigned clinical areas to assist with investigation of problems, and the development and monitoring of corrective actions.
- Works closely with the senior management team in the implementation of organizational Medicare goals, strategies and risks. Collaborates with Finance and Compliance in planning, developing and submitting the annual Medicare report in a timely and thorough manner. Works with Medical Director to facilitate accurate, complete and timely reporting of annual quality measures for UCR Health to CMS for the Medicare Shared Savings Program (MSSP), CPC+ and to other payers for value based contracts.
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15 |
Under general supervision, coordinates the management of data and documents between Quality and other departments. Assists in researching best practices and in developing proposals for improvements in the data collection processes.
- Supports the development, enhancement and sustainment of the data warehouse, ensuring that it supports operational, compliance, performance improvement, and business reporting needs across the organization. Works with IT Interface Analysts to assist in quality assurance of clinical files for population of quality measures in data warehouse system.
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15 |
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Analyzes and interprets data of moderate complexity and summarizes statistical findings. Develops corresponding reports, dashboards, and presentations. Assists with developing action plans.
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10 |
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Works on incident reports and QI reviews of moderately-complex cases as assigned, including mortalities, sentinel events, and readmissions. Flags cases that may require immediate review and response and develops or participates in development of appropriate actions.
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10 |
Assists in preparing reports of patient care and safety data to appropriate internal departments and outside agencies.
- Responsible for uploading and troubleshooting data from UCR Health data warehouses to CMS through their web interface system for quality reporting submission. Tracks and monitors community reporting progress during annual reporting period. Collaborates with units/departments to prepare for and comply with required reporting and data compliance audits.
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10 |
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Works with clinical and technical staff on projects of limited scope, applying moderately-complex QI models and techniques to improve clinical care and patient safety, and identify opportunities for continued quality improvement.
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10 |
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Other assignments/projects as assigned. Travel to multiple clinic sites and university locations.
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10 |
