Position Summary: The Clinical Quality Specialist oversees the clinical documentation review program and other quality programs for the clinical teams. Core functions are to enhance the performance of the clinical teams through creating, monitoring and facilitating the work of the clinical quality review committee in the areas of clinical performance and quality, compliance with Eventus clinical protocols, processes and procedures. Two areas of responsibility include: (1) Clinical Services, (2) Integration of clinical quality review program with auditing and monitoring team ESSENTIAL DUTIES AND RESPONSIBILITIES: The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive, other duties may be assigned: Team Leadership/Supervision
Oversee the clinical performance and achievement of Eventus providers: - Foster an engaging culture among all teammates
- Monitor adherence to established and documented Eventus clinical standards, processes and procedures as written by specialty specific clinical directors. Receive and react to clinical quality data reports
- Regularly review documentation and coding of care team members to ensure compliance and quality
- Receive and analyze clinical quality data reports; reacting and counseling team members, as needed, to maintain standards
- Collaborate with collaborating physicians, clinical leaders, and/or director of clinical services, when specialty specific guidance is needed.
Quality Committee Performance
- Ensure committee performance is on time and that all providers receive timely reports and follow up education as needed
- Collaborate with other team leaders to ensure clinical data reports are well understood
- Monitor and ensure improvement over time with clinicians in their clinical quality
- Ensure committee members are documenting CCM time as they complete their work
- Work closely in collaboration with auditing and coding team to ensure smooth and cohesive process among the quality review team with the auditing and coding team
- Work closely in collaboration with the training team in reviewing/monitoring/teaching providers improvements to be made in clinical quality
Clinical Services
- Perform clinical services within the standards of Eventus WholeHealth clinicians for area of clinical specialty
- Provide backup and fill-in clinical services (e.g., PTO and uncovered buildings coverage) when needed and work alongside providers in trainings or starting up new buildings, to ensure that all patients within the care team are serviced.
- Clinical services are expected to be at least 60% of the productivity requirements but with potential for change over time as role continues to develop
EDUCATION AND/OR CERTIFICATIONS
- Clinical Masters or Doctoral Degree
- National certification for area of specialty
- Unrestricted license in area of specialty within the state of practice
SKILLS AND QUALIFICATIONS
- Previous or current long-term care experience required
- Experience leading integrated healthcare teams a plus
- Demonstrated experience with an Electronic Health Record (EMR) and/or practice management system
- Excellent PC skills required
- Strong leadership skills and the ability to effectively coach, motivate, and develop others.
- Excellent oral, written and interpersonal communications skills, with the ability to bring individuals together.
- Ability to work collaboratively and coordinate care with a multi-disciplinary team Ability to effectively handle multiple priorities
- Possess outstanding organization skills and an ability to multi-task while maintaining a customer focus
- Demonstrate creativity, problem-solving, adaptability, and flexibility
- Knowledge of HIPAA privacy laws
- Must possess an understanding and adherence of legal and regulatory agency rules and guidelines
- Drive to help patients and staff with tact and diplomacy
LANGUAGE SKILLS:
- Ability to communicate clearly and concisely in verbal and written form.
- Strong communication skills and a customer service attitude.
- Must be able to frequently communicate with facilities and patients and/or with others about patient or provider requirements, complaints, and common inquiries.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the job.
- While performing the duties of this job, the employee is regularly required to communicate with others, including the ability to express oneself and exchange information in what, at times, could be a stressful or high-pressure environment.
- The employee frequently is required to move about the office to access files, use office equipment, and to interact with others.The person must be able to sit, walk, or remain in a stationary position for extended periods of time to be able to work, communicate on the phone, utilize the computer, and interact with others.The employee is occasionally required to stand or otherwise be able to access files, equipment, and other items in high places.
- Employee must be able to constantly operate computers, phones, and other office equipment.
- Employee must be able to bend, stoop, kneel, crouch, or crawl.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the job.
- The noise level in the work environment is usually moderate to high.