General Information
| Payroll Title | UNCLASSIFIED | Title Code | 009999 | Grade/Step | 10 | Working Title | Quality Outcomes Manager |
|---|---|---|---|---|---|---|---|
| Department Name | Clinical Affairs Dept | Supervisor | Kim, Taekyu | Department Head | Michael N Nduati |
Special Requirements and Conditions
| Critical Position |
| Travel |
Level of Supervision Received
| General Direction |
Items Used
| Standard office environment. |
| Will also spend time in a physician clinic setting. |
Position Purpose
| This position understands, implements, and educates to create better practices/processes for improved outcomes for our patients in compliance with regulatory agencies such as Centers for Medicare and Medicaid Services (CMS) which have an impact to the financial being of the clinic setting. Provides project management support to clinic operations by collaborating with leadership in the changes to service lines and opening new clinic locations. |
Essential Functions
| Essential Function | % Time |
|---|---|
| Quality Initiatives / Improvement Management | 65 |
| Serves as subject matter expert on quality measures associated with initiatives and programs including but not limited to Meaningful Use, 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. 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. Ensures critical reporting solutions are delivered to requesting departments in an effective and timely manner. Develops initiatives including self-service reporting solutions, data trending analyses, member and provider profiling, data mining, data analysis, and promoting a data aware culture throughout organization. Collaborates with units/departments to prepare for and comply with required reporting and data compliance audits. Participates in all Quality Improvement Activities to ensure interventions are adjusted as needed and results are presented to regulators and/or committees. Focus on continuous improvement; implement efficiencies to achieve best resource utilization while reducing costs. Develops and maintains collaborative working partnerships with other internal departments. Works closely with the senior management team in the identification and development of organizational Medicare goals, strategies and risks. Works with external vendor(s) if needed in planning and implementing Medicare specific initiatives, and manage the terms of the vendor service agreement. Recommends strategic changes if necessary to improve the program results. 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. Provides client education and training on quality measures and reporting submission process. Promotes best practices and standards. Tracks and monitors community reporting progress during annual reporting period. Supports staff and faculty through reporting period by providing interpretive guidance on clinical quality measure specifications to achieve maximum performance within each measure. Provides education to internal key stakeholders on quality measure updates. Responsible for uploading and troubleshooting data from UCR Health data warehouses to CMS through their web interface system for quality reporting submission. Assists in webinars and dissemination of quality related documents. Works with IT Interface Analysts to assist in quality assurance of clinical files for population of quality measures in data warehouse system. Analyzes quality results and disseminate to stakeholders. Develops and creates process improvement strategies to improve productivity, quality, and customer satisfaction. Supports process improvement to optimize efficiency of operations. |
|
| Operations Project Management | 25 |
| Coordinates workflow and process development and documentation between Medical Services and other departments. Provides project management support on select projects that affect operations in Medical Services, as directed. Assists in the development, implementation and evaluation of the overall plan and structure for service lines. Provides tools and training solutions to address any gaps in knowledge, competency, and skills for support staff. Continually researches and identifies opportunities for process improvement, new training methods and activities and make recommendations for policy and process changes to enhance efficiency and effectiveness. Assists in the development and implementation of operational practices, as well as interfaces with internal departments to ensure our service is delivered in a service oriented manner and according to regulatory requirements, policies, and procedures. |
|
| Other Duties / Travel | 10 |
| Other assignments/projects as assigned. Travel to multiple clinic sites and university locations. |
|
Minimum Requirements
| Minimum Requirement | Display Ranking |
|---|---|
| 1 | |
| Bachelor's Degree in a related field required. |
|
| 2 | |
| Five years of high level administrative experience coordinating programs and multiple projects. | |
| 3 | |
| Knowledge of medical office practices, procedures and methods; knowledge of EHR applications. | |
| 4 | |
| Excellent critical thinking and problem-solving skills. | |
| 5 | |
| Demonstrated ability to develop and manage work plans and to prioritize, organize, and systematically handle a variety of tasks simultaneously. | |
| 6 | |
| Advanced communication and interpersonal skills. | |
| 7 | |
| Ability to work effectively with staff/faculty from diverse ethnic/racial backgrounds, educational levels, sexual orientations and identities. | |
| 8 | |
| Ability to work independently under general direction and to work collaboratively with others. | |
Preferred Qualifications
| Preferred Qualification | Display Ranking |
|---|---|
| 1 | |
| Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), Quality Assurance Reporting Requirements (QARR), National Committee for Quality Assurance (NCQA), Medicare Shared Savings Program Accountable Care Organization (ACO) and Group Practice Reporting Organization (GPRO) measures. | |
| 2 | |
| Project management and quality improvement techniques/methodology including process mapping and work-flow analysis tools experience. | |
| 3 | |
| Computer proficiency and first-hand experience in using electronic health records systems to document patient interactions and coordinate care. | |
| 4 | |
| Advanced Excel skills including the use of conditional formatting, formulas, pivot tables and charts. | |
| 5 | |
| Knowledge of database design. | |
| Posted Position Purpose |
|---|
| This position understands, implements, and educates to create better practices/processes for improved outcomes for our patients in compliance with regulatory agencies such as Centers for Medicare and Medicaid Services (CMS) which have an impact to the financial being of the clinic setting. Provides project management support to clinic operations by collaborating with leadership in the changes to service lines and opening new clinic locations. |
| Posted Minimum Requirements |
| -Bachelor's Degree in a related field required. -Five years of high level administrative experience coordinating programs and multiple projects. -Knowledge of medical office practices, procedures and methods; knowledge of EHR applications. -Excellent critical thinking and problem-solving skills. -Demonstrated ability to develop and manage work plans and to prioritize, organize, and systematically handle a variety of tasks simultaneously. -Advanced communication and interpersonal skills. -Ability to work effectively with staff/faculty from diverse ethnic/racial backgrounds, educational levels, sexual orientations and identities. -Ability to work independently under general direction and to work collaboratively with others. |
| Posted Preferred Qualifications |
| -Knowledge of Healthcare Effectiveness Data and Information Set (HEDIS), Quality Assurance Reporting Requirements (QARR), National Committee for Quality Assurance (NCQA), Medicare Shared Savings Program Accountable Care Organization (ACO) and Group Practice Reporting Organization (GPRO) measures. -Project management and quality improvement techniques/methodology including process mapping and work-flow analysis tools experience. -Computer proficiency and first-hand experience in using electronic health records systems to document patient interactions and coordinate care. -Advanced Excel skills including the use of conditional formatting, formulas, pivot tables and charts -Knowledge of database design. |