Location: Columbus,OH, USA
Classification Purpose: The primary purpose of the Quality Improvement Specialist classification is to assist with the organization, planning, development, implementation, and coordination of a continuous quality improvement plan. Assist with the coordination of internal and external quality assurance activities. Oversee and maintain quality assurance of assigned home health care agencies in order to provide diverse and individualized services to older adults in their homes.
Job Duties: Monitor, evaluate, and train agencies providing health care services to older adults in their homes. Conduct official pre-certification, post-certification, and annual review site visits and audits at home health care agencies to determine compliance with contract requirements. Ensure compliance with federal, state, and local laws and contractual rules and regulations. Prepare exit conference summary and structural compliance review, written plans of correction, reports, and correspondence for the agencies. Monitor agency's plan of correction. Provide technical assistance to agency administrators to assist in maintaining and improving regulatory compliance, quality practice, and consistency between planned and actual services. Assist providers in maximizing their management and service delivery system efficiency and minimizing wasted effort. Interpret program requirements for providers. Develop and provides reports, forms, and data to assist agency administrators in managing service delivery. Recommend when cautions to providers are warranted for substandard performance. Take disciplinary action when necessary. Recognize exemplary performance of agencies. Develop and maintains tracking system for monitoring agency performance. Develop forms and tools for formally evaluating agency. Provide and maintains a pool of diverse service providers. Design and updates tools and documents for case managers to use when making provider awards to client care plans.
Resolve and negotiates client, caregiver, case manager, and provider complaints. Investigate and verify information and makes recommendations. Resolve billing and invoice disputes between provider and client. Calculate and approves adjustments to client and provider invoices. Complete billing change forms. Maintain accurate and up-to-date records and documentation in accordance with agency standards. Develop and designs systems to maintain client and provider relationships. Serve as consultant and advisor to clients, agency providers, and case managers.
Assist in the development of mechanisms to assure best practice. Facilitate workgroups to assist program teams with process improvement and development of program policies and procedures. Conduct research and design flow charts, team charters, bar graphs, surveys, grids, etc. to assist in process and with presentations. Facilitate team development activities. Mediate interpersonal conflicts among staff. Assist in the development, facilitation, and implementation for the agency's strategic business plan. Facilitate workshops. Assist program staff in developing purpose statements, services, and program performance measures. Conduct orientation for new staff and students. Complete employee exit interviews as assigned.
Assist in the coordination of the Invitation to Bid for in-home care services, medical transportation, and central order contracts conducted in conjunction with the purchasing department. Assist in developing goals and objectives to determine appropriate standards for services delivered. Write and revise Conditions of Participation and Service Specifications for contracts. Evaluate provider application packets for compliance with Invitation to Bid. Researches and verifies business history. Complete and documents reference checks for applicants. Schedule and conducts pre-certification visit. Evaluate agency's compliance with Invitation to Bid contract requirements. Make decision to recommend agency for contract. Maintain and updates case management system. Communicate with general public to inquire about becoming a provider. Maintain and updates list of interested parties. Assist in the gathering and analysis of program impact data. Plan, design, conduct, evaluate, and analyze agency surveys. Compile and generates reports from completed surveys. Present results. Attend meetings. Coordinate and monitors assigned special agency projects. Participate in various advisory boards, task forces, councils, coalitions, and committees in the community. Maintain regular and predictable attendance.
These duties are illustrative only and you may perform some or all of these duties or other job-related duties as assigned.
Major Worker Characteristics: Knowledge in budgeting; work force planning; employee training and development; public relation; human relations; agency policy and procedures; government structure and process; social sciences. Skill in word processing; equipment operation. Ability to carry out detailed but basic written, oral or picture form; deal with problems involving several variables in familiar context; apply principles to solve practical everyday problems; define problems, collect data, establish facts and draw valid conclusions; deal with some abstract concrete variables; copy material accurately and recognize grammatical and spelling errors; complete routine forms; complete routine forms; maintain accurate records; interview job applicants effectively; understand manuals and verbal instructions, technical in nature; prepare meaningful, concise and accurate reports; prepare and deliver speeches before specialized audiences and general public; gather collate and classify information about data, people or things; cooperate with coworkers on group projects; handle sensitive inquiries from and contacts with officials and general public; resolve complaints from angry citizens, and government officials.
Minimum Class Qualifications for Employment: Any equivalent combination of relevant training and experience including but not limited to: Bachelor's degree in human service or related field with two (2) years of human service, social service or related experience.
Additional Requirements: No special license or certification is required.
Supervisory Responsibilities: None required.
Unusual Working Conditions: N/A