Job Description

The Quality of Care Educator, under the direction of the Vice President of Quality, is responsible for the Quality of Care Program for the MSO of Steward Health Care Network.  The position is responsible for the overall development and implementation of the patient safety process, staff education on the recognition of patient safety and quality of care concerns and the oversight of policy compliance with state and federal regulations on patient safety and quality of care.

 

Coordinates data collection on quality of care concerns and monitoring, tracking, trending, and analyzing of all other quality of care data to identify root causes and improvement opportunities to recommend program / process changes, policy updates, etc.  Maintains database and reports to Health Plan Quality leadership in the intervention programs when patient safety issues and gaps in care are identified.

 

Responsible for coordination of activities and data infrastructure related to the quality of care process and grievances, quality of care reports and performance measures, and other quality of care activities as assigned, including medical record or pertinent document review, interviews of personnel as necessary, and state / federal reporting requirements applicable to each line of business within required turnaround time.

 

Leads investigation of patient safety and quality of care concerns, including onsite investigations, when appropriate, and plans for resolution of all safety related incidents posing a threat to members and providers.  Accountable for complete and efficient quality of care case summaries.

 

Tracks and trends data for quality of care and patient safety concerns to identify root causes.  Leads in the implementation of opportunities for performance improvement in the care of health plan members.

 

Supports Appeals and Disputes (A/D) department with clinical reviews and serves as a clinical liaison to the A/D coordinators for state fair hearings and other clinical projects.  Writes and delivers acknowledgment and closure letters on all cases.  Prepares identified cases for review at the Peer Review and / or Quality Committees, as appropriate.

 

Assists in growth and development of clinical quality of care programs, training materials, and annual educational programs for health plan staff in the recognition and effective reporting of patient safety and quality of care concerns, increasing awareness of patient safety initiatives.

 

Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.

Equal Opportunity Employer Minorities/Women/Veterans/Disabled

 



Qualifications

Qualifications:

A Bachelor's degree or equivalent certification / work experience / education required

Master's degree preferred

Three (3) or more years in a health care quality focused role

Three (3) or more years in a supervisory role preferred

Significant experience in analytic functions, quality assessment, and medical record review with the ability to track and trend outcome measures

Excellent verbal and written communication skills

 

Application Instructions

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