Metro Health (now the University of Michigan Health-West) is looking for Sr. Quality Management Specialist -  - Clinically Integrated Network * Days - 40hrs/week

　　General Summary:

　　Under the direction of the PHO Director, the Senior Quality Management Specialist is the primary connection between the PHO and the practices. The Senior Quality Management Specialist will develop and maintain provider relations, monitor utilization management and ensure quality improvement. The Senior Quality Management Specialist has the responsibility for the creation and implementation of process improvement programs in support of Quality and Clinical Integration team initiatives. The Senior Quality Management Specialist also functions as the primary source of staff education relating to quality and utilization improvement as well as assisting the physician offices teams with health plan contracting initiatives. The Senior Quality Management Specialist will work with contracted health plans on clinical and quality initiatives as jointly defined by the PHO and the health plan.

　　Knowledge, Skills and Abilities:

　　Bachelor Degree in nursing, business or other health-related field. Master's Degree preferred.Minimum of five (5) years of experience in a related field.Managed care or care management background required.Skill and proficiency in applying quality principles and concepts.Advanced communication and interpersonal skills with all levels of internal and external customers. This includes, but is not limited to, medical staff, patients, families, clinical personnel, support and technical staff, outside agencies, and members of the community.Knowledge of computer software and hardware applications.Must be self-motivated, able to work independently, make decisions and take appropriate action when concerns arise.Ability to work with sensitive and/or confidential information.Ability to make effective decisions, judgment, and incorporate problem-solving methods.A high degree of professionalism is essential for all contacts with patients, family members, staff, referral sources, and co-workers.Essential Functions and Responsibilities:

　　Work as part of the PHO team to design, manage, and oversee provider education and training programs to include the following:Health plan incentive programs including but not limited to BCBSM PGIP, Blue Care Network Physician Recognition Program, Priority Health Physician Incentive Program, and Molina incentive programs.Patient registries and EMR reporting tools including but not limited to EPIC, Wellcentive, and Health E-Blue.All other quality and clinical programs as needed.In cooperation with the PHO Director and Clinical Quality Manager, participate in the continuous evaluation and improvement of the strategic plan to meet the reporting needs of the Quality and Clinical Integration team strategic objectives.Investigate and report quality and compliance issues identified through the review of clinical, utilization, cost, case mix, and decision support reports to the Quality and Clinical Integration team.Prepare payer work plans as needed.Maintain strict confidentiality regarding patients, employees, and medical staff issues.Assist with the evaluation and improvement of the Quality Improvement and Utilization Management Program and annual Plan and Evaluation.