As a Clinical Quality Specialist, you will: 

• Participate in a rigorous quality assurance program supporting a centralized multidisciplinary care management team ensuring all programs and workflows are being followed and delivered to patients as intended

• Perform a clinical call quality program to ensure the highest quality telephonic interactions are occurring between our team and patients, families, and physicians.   This program will include mechanisms to acknowledge our high performers and identify team members that need additional coaching and training to be successful

• Have a deep understanding of the approved care management processes and workflows within the care management system applications

• Participate in the inter-rater reliability (IRR) process that includes routine reviews of results with department leaders and team member coaching

• Prepare and deliver structured review and audit result reports to managers and leaders

• Strive for excellence and seek to support the multidiscipline clinical team in providing high quality, highly effective communication techniques and skills

A Day in the Life:

• Perform detailed and documented reviews of the care management processes and workflows identifying team members or specific processes that need additional training.  This also includes identifying processes that are not working efficiently or as designed and providing that feedback to the Performance Improvement Specialist who will then lead a performance improvement process.

• Listens to recorded calls between our clinical team and patients/families

• Measures, documents, and reports results against a set of defined criteria ensuring the processes, workflows and calls meet the highest quality standards 

• Aggregates results of audits

• Reviews results with the Senior Quality Assurance Specialist and other managers and team members as requested

• Seeks for opportunities to improve the quality proactively providing suggestions (i.e. ways to improve processes, improve the call scripts, ways to improve the process used to call patients etc.)

• Participates in the IRR process

• Serves as a resource to entire team and department regarding quality matters

What Success Looks Like in this Role:

• Patients, physicians, families providing feedback that their telephonic experience with the Client Operations team was positive

• Care management team members are positively engaged, feeling supported, and following the approved workflows and processes and achieving the highest levels of performance excellence

• Strong relationships with the client operations care management team members, care team managers and the quality assurance specialists.  The Quality Assurance team is seen as a collaborative essential partner by the care management team managers and leaders.

• Patients in the Total Care Program develop healthy, appropriate, effective communication and relationships with care managers

• The care management team becomes highly efficient (takes fewer minutes on the call) and highly effective (patient outcomes such as appointments scheduled, and care gaps closed improves)

• Concise, easy to understand reporting to the care management team managers that supports quick identification of opportunities to work with team members that need additional support/coaching

• Concise meaningful routine reporting to leadership on results achieved by the clinical call quality program, demonstrating trended improvement over time

We are excited about you if you have these things:

• A personal commitment to a person-centered approach, along with strong relationship-building, communication, and active listening skills required

• Experience with care management team workflows and processes

• Experience with care management tools and applications

• Understanding of HEDIS and STARS

• Ability to handle a high workload and meet deadlines with a high level of accuracy

• Enthusiasm to work on complex issues and a strong desire to help find solutions

• Strong verbal and written communication skills 

• Must be a highly collaborative

• 2 or more years of Quality Assurance/improvement required

• Recent experience related to quality monitoring in a call center setting is preferred

• Bachelor of Science Degree in Nursing required

• Current, unrestricted (Missouri, RN) license 

• Certified Professional in Healthcare Quality (CPHQ) certification is desired

• Proficient use of Microsoft Office including Word, Excel and PowerPoint required