PacificSource Health Plans

Quality Incentive Measures (QIM) Practice Facilitator

US-OR-Bend
Job ID
2017-371
Type
Regular Full-Time
Hiring Pay Range
$55,000 - $75,000
# of Openings
1
Status
Exempt

Overview

Work with clinics and other patient care settings to improve their performance on Medicaid Quality Incentive Measures (QIMs). Facilitate quality improvement and practice transformation efforts through meeting with practice staff, sharing expertise in quality improvement best practices, and providing information about background of QIM measures, the specifications of QIMs, and provider incentives for improved performance.  This position is grant funded through December 31, 2018.  Additional funding opportunities will be evaluated prior to that date. 

Responsibilities

Quality Improvement – independent duties:

 

  • Facilitate quality improvement and practice transformation efforts in clinical care settings related to all Medicaid QIMs.
  • Collaborate with participating regional clinics and stakeholders to establish relationships, observe clinic operations and workflows, and implement and track quality improvement strategies to optimize QIM performance.
  • Lead and coordinate opportunities for peer to peer shared learning between internal QIM team and practice facilitators in community clinics.
  • Assist with the evaluation of initiatives to determine the effectiveness and make recommendations to improve outcomes. 

Collect or create project data:

 

  • Work with practices to identify data sources, provides technical assistance on use of data and reporting systems to drive performance improvement, and connects with health IT experts as needed.
  • Collect, organize, and share data and information between external and internal stakeholders, including how practices implement process improvements.
  • Track improvement initiatives through QIM work plan and Communicate with stakeholders to monitor data quality and intervention efforts.
  • Synthesize customer and third-party feedback into operational solutions that drive on-going enhancements to member experience. 

Collaboration:

 

  • Support internal staff to identify and implement strategic internal and community initiatives aimed at maximizing member outcomes and QIM results.
  • Participate in relevant community partnerships and workgroups.

Compliance and contracting:

 

  • Maintain good working knowledge of Medicaid rules and regulations and ensures that the project operations remain compliant; including policy & procedure development, work plan, and annual evaluation reports.
  • Prepare, implement, and monitor annual work plans and QIM improvement plans.
  • Prepare relevant documents and participates in compliance activities.
  • Shared accountability with the internal QIM team for ensuring responsible parties are improving QIM performance both internally and externally.

Supporting Responsibilities:

 

  • Participate in and supports project teams led by other departments and provide necessary input to support the goals of colleagues.
  • Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
  • Perform other duties as assigned.

Qualifications

Work Experience: At least five years of experience in healthcare with a strong clinical focus. Experience in quality improvement, practice facilitation, and program development.

 

Education, Certificates, Licenses: Clinician preferred with current Oregon license; significant in-clinic experience may substitute for a clinical license.  Bachelors or equivalent degree desired.

 

Knowledge: Knowledge and understanding of disease prevention, medical procedures, care modalities, procedure codes, including ICD-10, CPT Codes, health insurance, and State of Oregon mandated benefits. Ability to develop, review, and evaluate utilization reports. Knowledge of quality improvement methodology. Experience giving presentations. Organizational skills with solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.

 

Competencies

Our Values

  • Building Customer Loyalty
  • Building Strategic Work Relationships
  • Contributing to Team Success
  • Planning and Organizing
  • Continuous Improvement
  • Adaptability
  • Building Trust
  • Work Standards

 

 

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We encourage creativity, innovation, and the pursuit of excellence.

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel within the region is required approximately 50% of the time. Infrequent overnight travel.

 

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

 

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

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