Clinical Specialist - Performance Improvement
Under the general supervision of the Director of Quality Improvement, the Clinical Specialist for Performance Improvement is responsible for assisting in the comprehensive reporting of HEDIS (Healthcare Effectiveness Data and Information Set) measures and the reporting of Michigan Mission-Based Performance Indicators (MMBPI) and other key quality measures that assess various aspects of healthcare performance.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Works with the Provider Network and DWIHN’s departmental units for monitoring of HEDIS and Michigan Mission Based Performance Indicator (MMBPI) scores.
- Develops, writes and maintains effective Quality Improvement plans based on NCQA and HSAG requirements.
- Facilitates Provider Data (HEDIS, MMBPI) Improvement Workgroup meetings.
- Participates in Quality Workgroups focused on HEDIS, and other quality measures.
- Creates Quality improvement projects and design interventions.
- Creates reports for internal teams and/or external clients.
- Creates graphs, infographics and other methods to visualize data.
- Creates presentations based on recommendations and findings
- Collects, analyzes, interprets, and summarizes data in preparation for generation of statistical and analytical reports.
- Maintains computerized collection and tracking of relevant data
- Provides follow-up on the results of interventions and documents findings and limitations.
- Demonstrates and maintains current working knowledge of required systems, procedures, forms, and manuals
- Complies with NCQA and HSAG accreditation requirements as well as other state and federal regulations.
- Facilitates quality improvement intervention activities meetings and discussions within DWIHN.
- Works with the Director and Administrator to establish document quality assurance process to ensure the integrity, completeness and validity of external and internal reports
- Writes and produces accurate reports and conducts analyses according to set timelines and project plans.
- Measures and evaluates attainment of results.
- Collaborates with other DWIHN units to ensure communication, teamwork and integration to support achievement of desired improvements.
- Provides assistance in reviewing Critical and Sentinel Events to assess whether the incident meets the criteria and definitions for critical events, critical incidents, risk events, sentinel events, or media events.
- Maintains all materials as confidential and distributes only as necessary to perform the peer review function.
- Performs related duties as assigned
KNOWLEDGE, SKILLS AND ABILITIES
- Knowledge of DWIHN policies, procedures and practices.
- Knowledge of the principals of quality improvement.
- Knowledge of MDHHS policies, rules, regulations and procedures.
- Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
- Knowledge of NCQA requirements and the accreditation process.
- Knowledge of HEDIS measures and standards
- Knowledge of Quality Assurance.
- Knowledge of accreditation and certification standards related to the provision of mental health, developmental disability and substance abuse services.
- Computer skills
- Time management skills
- Organizational skills
- Critical thinking skills
- Teamwork skills.
- Conflict Resolution skills
- Decision Making skills
- Project Management skills
- Assessment skills.
- Report writing skills.
- Communication skills.
- Multitasking skills.
- Analytical skills
- Ability to communicate orally.
- Ability to communicate in writing.
- Ability to work effectively with others.
- Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
- Judgement/Reasoning ability
REQUIRED EDUCATION:
A Bachelor’s or Master’s Degree from a recognized college or university in Business Administration, Public Health, Public Administration, Mathematics, Statistics, Information Technology, Healthcare Administration, Health Care Management, a Human Service, Social Service or a related field.
REQUIRED EXPERIENCE:
- Three (3) years of full-time paid professional experience working in a human service, social service, mental health, or behavioral health setting performing duties and responsibilities in the following areas:
- Quality Management/Quality Improvement
- HEDIS Audits
- NCQA or related certification
REQUIRED LICENSE(S).
A valid State of Michigan Driver’s License with a safe and acceptable driving record.
WORKING CONDITIONS:
Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently this position is primarily a remote position.
This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.
Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer
