Quality Improvement Specialist Plano, TX

Quality Improvement Specialist

Full Time • Plano, TX
Job Summary 
The Quality Improvement Specialist is responsible for promoting and overseeing a continuous quality improvement of documentation and network curriculum. This program will include responsibility to maintain the quality control of standardized documentation and process across markets.   
 
Role and Responsibilities
  • Develops Network curriculum, provider manuals, guidelines, and onboarding process & documentation. 
  • Overall management of standardize documentation and workflows.  
  • Promote and perform continuous quality improvement monitoring.  
  • Compiles data for trend analysis and reporting so quality action plans can be developed and implemented. 
  • Oversees the Quality Action Plans and reports back to leadership. 
  • Facilitates meetings as required to meet targets related to department and company goals.  
  • Continuous mindset toward efficiency and process improvement – how to apply technology and processes to improve delivery and efficiency from both the Provider Group and internal perspective.
  • Responsible for coordinating and facilitating meetings with performance advocates 
  • Review policies, procedures and workflows, recommending revisions when necessary to comply with regulatory and accreditation standards (HIPAA, DOL/ERISA, UM & CM URAC, NCQA, etc.), and facilitating completion and implementation of revisions. Monitors that staff comply with the established written policies and procedures. 
  • Participate in accreditation initiatives and assist with completion of activities.  
  • Assist in developing and updating URAC, Departments of Insurance and NCQA compliance materials with documentation to demonstrate compliance with regulations/standards. 
  • Assist in completion and submission of accreditation applications. 
  • Oversees orientation and training for new hires. 
  • Maintains team audits, competencies, and curriculum and test inventories. 
  • Partners with other departments in planning the training programs, curriculum, and activities. 
  • Performs other related duties as assigned. 
 Qualifications and Education Requirements 
  • Associate degree required. College education preferred. 
  • Minimum of 2 years’ experience in healthcare  
  • Working knowledge of Quality Improvement principles and incorporating them into daily functions. 
  • Proficiency in computer and software programs (e.g. Microsoft Word, Excel).  
  • Effectiveness in communication style (written and verbal), with proven ability to positively influence behavior toward a positive outcome.  
  • Self-motivated with the ability to work independently, as well as within a team environment.  
  • Proficient in data analysis, error discovery and resolution. 
  • Ability to adapt and quickly learn electronic programs utilized for research. 
  • Positive, service-oriented attitude. High level of integrity. 
  • Ability to multi-task and work closely with all associated in data capture and analysis. 




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