PRINCIPAL RESPONSIBILITIES:

The Quality Improvement (QI) Project Specialist II is responsible for developing and implementing quality assessment and performance improvement activities that includes facilitation, quality monitoring, and evaluation of improvement projects. The QI Project Specialist II, as directed by Quality Improvement (QI) leadership, facilitates Quality Improvement Health Equity (QIHE) program administration activities, cross-collaborative projects with internal and external partners, and projects to ensure compliance with regulatory and accreditation bodies. The distinction to a Quality Improvement Project Specialist II includes greater knowledge and application of technical specifications in assigned quality improvement projects or programs, design of projects requiring critical thinking with data-driven strategies, and complex analysis and reporting of QIHE activities.

Principal responsibilities include:

• Develops, plans, and implements a portfolio of multiple projects/initiatives within a specific QI program involving cross-collaboration across Divisions for internal or external systems (i.e. providers, community-based organizations, hospitals, etc.), such as Healthcare Effectiveness Data and Information Set (HEDIS)/Managed Care Accountability Set (MCAS), Alliance Pay-for-Performance program, State mandated Quality or Performance Improvement Projects (PIPs), Access to Care Surveys, Clinical Safety, or other QIHE activities to improve health outcomes
• Develop, plans, and implements the design and execution of updated regulatory mandates or new quality programs (e.g. behavioral health quality program, value-based payment programs, or skilled nursing facility/long-term care, etc.), including quality metrics, completion of workplan activities, and monitoring
• May serve as a practice coach for an assigned clinic(s) utilizing project management or quality improvement methodologies to improve quality health outcomes or access
• Coordinates activities with health care related vendors to support QIHE programs and improvement (e.g HEDIS/MCAS, Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• Facilitates completion of QIHE program description requirements, workplans, and program evaluation with involved departments
• Develops and facilitates completion of workplan activities for a given project or assigned QIHE program
• Develops visual trackers, program materials, and other tools to communicate QIHE program or department activities internally and externally to support QIHE program development and related activities
• Conducts gap assessment between operational activities and Medi-Cal contracts to ensure alignment with accreditation, regulatory and contractual standards, guidelines and/or requirements.
• Performs complex data analysis, root cause analysis, and ad hoc reports for performance measurement and outcomes towards QIHE Program goals
• Utilizes advanced data analysis (in collaboration with Analytics) to identify actions or projects to address and close health disparity care gaps
• Collaborates on projects in the advancement of quality improvement and health equity principles, including the Alliance’s Population Health Management program and Diversity Equity Inclusion and Belonging framework
• Evaluates quantitative and/or qualitative reports for accuracy of data
• Assists in identifying, assessing, and modifying current or new processes and creating process documentation for QIHE activities
• Works with Lead Quality Improvement Project Specialist and QI Leadership to identify QI training needs and develop appropriate trainings for internal (i.e. Alliance staff) and external stakeholders (i.e. provider network)
• Updates operational policies and procedures as delegated.
• Manages, facilitates, or drafts content for members and provider communications as appropriate to each project or program assigned.
• Manages internal and external meetings for an assigned project or program to faciliate achievement of project goals or outcomes
• Prepares meeting materials and complete meeting minutes when warranted.

ESSENTIAL FUNCTIONS OF THE JOB

• Demonstrate strong verbal and written communication skills.
• Ability to articulate the technical specifications and implement activities applicable to Healthcare Effectiveness Data and Information Set (HEDIS), Alliance Pay-for-Performance, State mandated Quality or Performance Improvement Projects (PIPs), Access to Care Surveys, Clinical Safety, or other regulatory requirements within the QIHE program.
• Ability to develop QI project plans, timelines, and incorporate data-driven strategies, such as collection, analysis, and evaluation of project goals and outcomes
• Strong data analytical skills in order to summarize trends and provide recommendations for proposed solutions to improve health outcomes
• Performs and presents advanced statistical data analysis and implementing projects in accordance with research design.
• Under QI Leadership, perform research and gap assessment pertaining to program outcomes evaluation metrics or standards, such as National Committee for Quality Assurance (NCQA), Agency for Healthcare Research and Quality (AHRQ), United States Preventive Care Task Force (USPSTF), or State regulatory requirements.
• Participates in cross-training and assists the Lead QI Project Specialist to orient new staff.
• Data collection, measurement development, maintenance, and analysis
• Reports and presentation development to support regulatory submissions
• Utilizes advanced tracking mechnisms via Microsoft Word, Excel, or Smartsheet to manage projects or programs.
• Prepares content and present on quality improvement activities at QI workgroups, sub-committees, or as appropriate, internal and external committees.
• Coordinates and consults with Alliance departments on QI activities and projects.
• Keeps abreast of healthcare industry best practices and managed care regulatory requirements.
• Complies with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and various other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Bachelor’s degree or equivalent work experience in health sciences or related field.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Three years of relevant project management and QI experience.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Completion of a training program, series of courses, or equivalent in quality/performance improvement methodologies, project management, or change management principles preferred.
• Certification in Certified Profession in Healthcare Quality (CPHQ), LEAN, or Six Sigma preferred.
• Working knowledge of health plan and delivery system operations, healthcare informatics, healthcare benefits and terminology, and medical practice operations
• Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes.
• Strong communication and presentation skills, training/meeting facilitation skills a plus.
• Solid relationship building and interpersonal skills.
• Excellent writing, research, analytical, and time management skills.
• Excellent coordination skills, including multi-tasking and setting priorities on work assignments.
• Ability to organize and coordinate various activities related to research, collaboratives and demonstration projects.
• High degree of independence, flexibility, initiative and commitment.
• Demonstrate resourcefulness in identifying and resolving complex problems.
• Ability to work effectively with diverse population, both internally and externally.
• Solid critical thinking and problem-solving skills.
• Ability to utilize sound judgment and promptly report potential risks.
• Ability to work in a fast paced, patient-service oriented environment.
• Must handle PHI and maintain confidentiality at all levels.
• Proficiency in Windows including Microsoft Office suite including Word, Excel, Visio, PowerPoint or Smartsheet.

SALARY RANGE $92,051.06 - $138,076.59 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.