ESSENTIAL JOB DUTIES
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Clinical Quality Measurement and Validation (30%)
- Lead the validation of clinical quality measures across GLBHC (UDS, HEDIS, HRSA, state and health plan measures), confirming that denominator and numerator logic is applied correctly and reflects actual clinical care
- Perform targeted and routine chart reviews to verify data accuracy, identify documentation gaps, and ensure that EHR workflows support accurate quality reporting.
- Partner with the Quality Data Analyst to review measure definitions, attribution logic, and population lists; provide clinical interpretation and feedback to refine reports and dashboards
- Investigate discrepancies between reported performance and clinical expectations; identify root causes and recommend corrective actions (documentation, coding, workflow, or system changes).
- Serve as a subject-matter resource for providers and staff on quality measure definitions, inclusion/exclusion criteria, and appropriate clinical documentation.
- Health Plan Navigation and Value-Based Program Support (25%)
- Act as the primary clinical resource for understanding and communicating payer quality expectations, attribution methodologies, incentive structures, and benefit designs that affect patient care.
- Work with health plans, ACO partners, and state programs to clarify quality and utilization requirements and translate them into practical guidance for GLBHC care teams..
- Collaborate with Referrals, Care Management/CHWs, Revenue Cycle, and site leadership to ensure alignment between health plan requirements, access workflows, and care-management activities.
- Monitor payer rosters, gaps-in-care lists, and performance reports; validate accuracy and coordinate follow-up with sites to address identified care gaps.
- Support GLBHC’s participation in value-based contracts by helping clinical teams prioritize high-impact measures, high-risk populations, and targeted outreach strategies.
- Clinical Practice Support and Performance Improvement (25%)
- Partner with providers and site managers to design and implement clinical workflows that support quality measures, and care-gap closure
- Lead or co-lead focused quality improvement projects (PDSA cycles) that address clinical outcomes, preventive care, chronic disease management, and patient experience.
- Provide one-on-one and group coaching to providers and care teams on documentation standards, coding related to quality measures, and effective use of EHR tools and registries.
- Participate in clinical huddles, site meetings, and multidisciplinary teams as the QI representative; bring forward data, highlight opportunities, and support problem-solving.
- Identify training needs and collaborate with Clinical Training and Development team to develop and deliver targeted education on quality workflows and tools.
- Team Leadership, Supervision, and Staff Development (10%)
- Directly supervise the Quality Data Analyst and outreach staff responsible for patient outreach, panel management, and quality campaigns (e.g., recalls, screenings, chronic disease follow-up)
- Provide clear expectations, regular feedback, and timely Career Development Reviews for assigned staff.
- Prioritize and assign analytic and outreach work in alignment with organizational quality goals and payer program requirements.
- Support staff development through coaching, cross-training, and opportunities to participate in improvement projects and committees.
- Foster a collaborative, patient-centered, and data-informed team culture focused on closing care gaps and improving outcomes.
- Reporting, Communication, and Compliance (10%)
- Assist the Quality Improvement Director in preparing internal and external quality reports for leadership, health plans, regulatory agencies, and grantors.
- Communicate measure performance, care-gap trends, and improvement priorities to providers and site leadership in a clear, concise, and actionable manner.
- Support preparation for audits, site visits, and accreditation or recognition activities related to clinical quality (e.g., HRSA, Grants, state programs).
- Ensure that QI activities, data handling, and outreach workflows meet regulatory and organizational standards for privacy, safety, and clinical quality.
Note: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for the job. Duties, responsibilities and activities may change at any time with or without notice.
MARGINAL JOB DUTIES
- Communicate with appropriate staff to improve processes with regards to EMR documentation and coding needs.
- Construct site and program activities to help improve quality care. Provide educational information to center managers and providers.
- Performs other duties as assigned.
JOB SPECIFICATIONS
- Education: Active, unrestricted Registered Nurse (RN) license in the State of Michigan is required. Minimum of five (5) years of combined experience in ambulatory or primary care clinical practice, population health, care management, and clinical quality improvement, with demonstrated responsibility for quality measures, data validation, and workflow improvement required. Bachelor’s degree or higher in Nursing preferred. Formal education, certification, or specialized training in quality improvement, population health, clinical quality measurement, or healthcare data analytics.
- Licensure: Current, unrestricted RN license in the State of Michigan preferred/required per discipline.
- Experience: Minimum of five years of experience in ambulatory or primary care clinical practice, population health or care management. At least two years experience in clinical quality improvement, including familiarity with UDS, HEDIS, or similar measure sets. Experience working with health plans, ACOs, or value-based payment programs.
- Skills: Strong understanding of clinical quality measures, documentation standards and basic coding principles relevant to quality reporting. Ability to interpret and validate data reports, identify trends, and translate findings into practical clinical actions. Demonstrated skills in project management, organization, and follow-through, with the ability to manage multiple priorities simultaneously.
- Interpersonal Skills: Able to build effective working relationships with Physicians, Advance Practice Providers, Nurses, Medical Assistants, behavioral health staff, outreach staff, and administrative personnel. Comfortable facilitating discussions, giving feedback, and supporting change in a respectful and collaborative way. Ability to navigate differing perspectives between health plans, and clinical teams.
- Physical Effort: Light, exerting up to 10 pounds frequently
- Hours of Work: Full-time. Flexible and varied. Position is not eligible for remote or hybrid status
- Travel: Frequent, weekly travel within service areas, some out-of-area travel. Reimbursement consistent with GLBHC policy.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
