QA - QI Specialist

Job Summary

Primarily responsible for coordinating Quality Improvement and Quality Assurance activities including licensing, performance-based data collection, entry and overall management of data reflecting organizational performance metrics. Responsibilities include but are not limited to conducting quality chart reviews, managing data sets, KPI and outcome reporting, CQI reviews, ensuring timely data reports, assisting in data analysis for documenting trends and collaborating with various departments and stakeholders around data integrity and potential solutions. This is a non-supervisory role.

Responsibilities

• Conducts quality reviews in accordance with licensing, certification, accreditation and managed care requirements and coordinates the flow of communication regarding areas for improvement.
• Conducts quality reviews for medical necessity and services provided.
• Gathers and reports upon statistical and narrative information regarding the utilization of services, discharges and quality of services, as required by leadership.
• Oversees the chart review in accordance with accreditation and licensing standards, and identifies areas in need of improvement.
• Compiles quality and performance outcome data to be used to help facilitate performance improvement.
• Reviews clinical documentation to assure compliance with managed care and other funding requirements; compliance with grant-funded requirements, that treatment recommendations are aligned with service planning documents, KPI's and performance measures.
• Identify ways to add value to treatment and discharge planning and work with clinical and care coordination staff to implement improvements.
• Collaborate with all departments to develop and maintain policies and operational procedures with established oversight systems to ensure full compliance with all funder, local and state regulatory and credentialing bodies for all programs.
• Develop and submit monthly reports to the AVP detailing results and areas of need in each audit.
• Supports additional data and quality improvement projects as needed.
• Performs the skills of CPR, the use of the AED, and First Aid on a resident in need, without delay.
• Other duties as assigned.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Social Work, Psychology, or a related field required (Master's degree preferred).
• Minimum of two to five years of experience in healthcare, behavioral health, or outpatient clinical operations, including at least two years directly dedicated to quality management, regulatory compliance, risk assessment, or clinical auditing.
• Proficiency in gathering, tracking, analyzing, and visualizing quality metrics, key performance indicators (KPIs), and outcome measures using data management tools is required.
• Preferred certifications: Certified Professional in Healthcare Quality (CPHQ), Lean/Six Sigma Certification (Yellow, Green, or Black Belt).
• Must have own transportation, possess a current/valid Driver's License, an acceptable Motor Vehicle Record (MVR) as mandated by Woods' insurance company. Local travel is expected.
• Must obtain and maintain an active CPR and First Aid Certification.
• Must be able to lift a minimum of 50 pounds, be agile, physically pursue clients on foot, physically restrain, bend, squat, stretch, reach, push up and stand for several hours at a time.