Quality Improvement Job Description
Quality improvement
provides oversight of programmatic and interventional activities in accordance with contractual, regulatory requirements and URAC and NCQA standards.
Quality Improvement Duties & Responsibilities
To write an effective quality improvement job description, begin by listing detailed duties, responsibilities and expectations. We have included quality improvement job description templates that you can modify and use.
Sample responsibilities for this position include:
Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
Serves as the Privacy Officer for First Home Care and Foundations for Home and Community
Facilitate and provide support to a multidisciplinary team to achieve clinical performance improvement goals and objectives
Review and abstract clinical data for regulatory data submission and identification
Communicate trends and patterns in data that will facilitate improvement
Identify and communicate trends and patterns in data that will facilitate improvement
Responsible for overseeing the required annual CAHPS and HOS surveys develop and implement quality improvement activities focused on improving these scores
This role participates in identifying and collecting metrics, data analysis and reporting information from the data collected
Establish and maintain open communication and professional working relationships with regulatory and accreditation bodies to ensure compliance with all applicable standards
Responsible for quality improvement aspects of risk adjustment processes for all products
Quality Improvement Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Quality Improvement
List any licenses or certifications required by the position: CPHQ, ASQ, ISO, CQM, CPPS, 9001, IATF, QMS, COS, LEAN
Education for Quality Improvement
Typically a job would require a certain level of education.
Employers hiring for the quality improvement job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Public Health, Health Care Administration, Communication, Computer, Medical, Science, Nursing, Performance, Engineering, Health Care
Skills for Quality Improvement
Desired skills for quality improvement include:
Community
State and federal laws and resources
JCAHO
Healthcare delivery
HEDIS and NCQA
URAC
AAAHC and NCQA standards
NCQA
Medicaid
Medicare programs
Desired experience for quality improvement includes:
Experience with quality reporting
OASIS certification required
Working knowledge of Quality Management, PI, Risk Management, Joint Commission Standards, and NJ DOH Regulations
Working knowledge of Quality Management, PI, Risk Management, Joint Commission Standards, NJDOH Regulations
Required A Bachelor's Degree in HealthCare, Nursing, Publich Health, Health Administration or directly related field
Required 7+ years of experience in directly related Quality Improvement job functions
Quality Improvement Examples
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Quality Improvement Job Description
Job Description Example
Our company is looking to fill the role of quality improvement. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for quality improvement
- Oversee provider satisfaction surveys and implement action plans for improvements
- Organize and control activities, methods, and procedures to achieve business objectives
- Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
- Present results of improvement efforts and ongoing performance measures to senior management
- Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
- Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards
- Review medical records and abstract data for HEDIS and other measure sets in compliance with standards
- Track and report on issues and outcomes related to abstractions and over-reads
- Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required
- Perform other quality initiatives as necessary
Qualifications for quality improvement
- Required Other For IL/MO RN License
- Knowledgeable on regulatory and accreditation standards related to quality and risk-related activities, PQOC investigations
- Intermediate level competency in Microsoft Word, Excel, Adobe, and Power Point
- Competency in using email
- Excellent verbal communication skills with the ability to communicate with participants and communicate professionally with individuals who serve in a variety of functions, physicians, account managers, brokers, customer service staff, Conifer, CVBC and IMMS management, other medical management nurses in supervisory roles, case managers, hospital utilization review nurses
- Required Other For FL/IA/IL/MO/NJ/CA/NE, a current unrestricted RN License
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Quality Improvement Job Description
Job Description Example
Our growing company is looking to fill the role of quality improvement. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for quality improvement
- Contributes to quality improvement of the organization by participating in supervision with the Regional Director Implements corporate risk management programs in a manner consistent with federal and state regulations corporate and licensure standards
- Develops and implements systems, policies and procedures for the identification, collections and analysis of risk related information
- Collects, evaluates, and maintains data conserving consumer injuries, claims, worker's compensation and other risk related data
- Assists in processing summons and claims against the facility by working with legal counsel to coordinate the investigation, processing and defense of claims against the organization
- Monitors FHC's and Foundations' compliance with accrediting and regulatory agencies including DHR, DMH, CFSA and Corporate offices
- Evaluates all sentinel events and critical incidents, interfacing with entity staff, corporate staff, and/or other auditing bodies as appropriate
- Facilitates and coordinates quarterly Quality Improvement Council and Committee meetings
- Investigates fraud, complaints and consumer grievances
- Trains staff on proper documentation linked with crisis events including incident reports, on-call logs and follow-up reports
- Monitors and supervises the work of QI Specialists
Qualifications for quality improvement
- Experience interpreting state regulations in health care facilities to ensure quality patient care
- Experience in the development and implementation of policy, systems and change concepts to prevent and reduce stroke and associated risk factors and impact healthy communities
- Experience facilitating change and driving large, diverse groups to consensus
- High School or GED with a current unrestricted RN license is required
- Bachelor's Degree in Healthcare, Nursing, Health Administration, Public Health or related health field is preferred
- 2+ years of experience in Quality Improvement is required
3
Quality Improvement Job Description
Job Description Example
Our company is looking to fill the role of quality improvement. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for quality improvement
- Establishes annual Quality Improvement Performance Goals in Conjunction with Medical Leadership
- Member of Quality Improvement Committee, CI Committee and others as assigned
- Reviews and evaluates quality metrics for ambulatory and inpatient care
- Collaborates with IT, Reporting and Analytics, Operations, Credentialing, Risk Management, Care Management and other areas in order to meet or exceed identified performance goals
- Integrate Quality Programs with Care Management Programs
- Cross cover UM, Referrals, and Case Management functions as necessary
- Manages staff in the functional area
- Serves as subject matter expert and represents the QI department in meetings and discussions about functional area
- Manages and negotiates vendor contracts to identify ways to reduce use of vendors and build internal knowledge or use internal resources instead
- Identifies new QI requirements and build out processes in advance of effective dates
Qualifications for quality improvement
- Experience in compliance and accreditation is required
- Knowledge of federal and state regulations/requirements is required
- Bachelor's degree in Nursing, related clinical degree or equivalent experience
- 7+ years of quality management, quality improvement or healthcare operations experience
- Minimum of two (2) years experience in a hospital setting required
- Clinical healthcare experience including but not limited to Registered Nurse, Licensed Pharmacist, Physical Therapist, Speech Therapist, Occupational Therapist, Registered Dietitian
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Quality Improvement Job Description
Job Description Example
Our innovative and growing company is looking for a quality improvement. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for quality improvement
- Compliance of the Quality Systems
- Create stability within the processes using lean six sigma and implementing standardized work
- Initiating and coordinating improvement initiatives on department/ COE level by proposing improvements and standardization, monitoring reports, leading Kaizen events and by training and coaching personnel
- Hands-on support to the business with problem solving techniques and facilitating root cause analysis or cross-functional investigations
- Utilizing tracking and reporting systems for analytical purposes, preparing plans and updating metrics, driving performance and assuring timely completion of improvements and goals
- Systematically and periodically examine, survey and sample the Company’s operational procedures, practices, plans, policies, standards and field installation practices and documentation in order to identify deficiencies and best practices in conjunction with Operational Quality Assurance (OQA)
- Perform quality activities to analyze quality deficiencies, determine causes and recommend corrective/preventative action
- Analyze operational quality assurance reviews to determine the estimated costs and risks associated with any deficiencies discovered by the review
- Use methods of statistical process control (SPC), such as run chart, determines what measurements to monitor and how to sample them
- Develop and conducts quality audits of contractor quality systems to determine their ability to provide services that meet the Company’s requirement in conjunction with OQA
Qualifications for quality improvement
- Patient care evaluation skills
- Ability to be an active, effective team member and team leader
- Ability to exemplify good interpersonal and facilitation skills Proficient in Microsoft Office software
- Basic knowledge of statistical process
- Five years clinical acute health care experience and at least two years’ experience in quality assessment
- High level of proficiency with MS Products, specifically Outlook and Excel experience with EMRs and aptitude to learn clinical systems
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Quality Improvement Job Description
Job Description Example
Our growing company is hiring for a quality improvement. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for quality improvement
- Use advanced quality tools and quality engineering principles to analyze quality deficiencies, determine their causes, and make recommendations for corrective and preventative actions to corporate management in conjunction with OQA
- Prepare written reports to management on quality assurance review observations and recommendations
- Maintain records of quality assurance review
- Conduct inspections of Company facilities and equipment
- Conducts contractor quality audits at contractors’ operation locations in conjunction with OQA
- Prepare written reports to management on contractor quality audits findings and observations
- Maintain records of contractor quality audits in conjunction with OQA
- Develop quality assurance training materials to be used in teaching and promoting good quality assurance practices throughout the division
- Evaluate the effectiveness of quality improvement measures
- Following corrective action, provide follow up review to assure that any operation quality deficiencies have been remedied
Qualifications for quality improvement
- One (1) year of quality improvement or statistical analysis experience required
- Working knowledge of PC required with basic keyboarding skills
- Ability to perform multiple duties in a heavy workload environment with constant change
- Knowledge of an automated outpatient appointment system required
- Knowledge of Cadence preferred
- 7+ years of experience in Quality Improvement required