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 outcomesDevelop, 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 monitoringMay serve as a practice coach for an assigned clinic(s) utilizing project management or quality improvement methodologies to improve quality health outcomes or accessCoordinates 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 departmentsDevelops and facilitates completion of workplan activities for a given project or assigned QIHE programDevelops visual trackers, program materials, and other tools to communicate QIHE program or department activities internally and externally to support QIHE program development and related activitiesConducts 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 goalsUtilizes advanced data analysis (in collaboration with Analytics) to identify actions or projects to address and close health disparity care gapsCollaborates on projects in the advancement of quality improvement and health equity principles, including the Alliances Population Health Management program and Diversity Equity Inclusion and Belonging frameworkEvaluates quantitative and/or qualitative reports for accuracy of dataAssists in identifying, assessing, and modifying current or new processes and creating process documentation for QIHE activitiesWorks 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 exte nal meetings for an assigned project or program to faciliate achievement of project goals or outcomesPrepares 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 i