Job Description

General Summary of Position
Participates in the continuous systematic monitoring of all MedStar Family Choice participating provider processes and outcomes; directs problem focused studies; implements and maintains department objectives to ensure compliance of NCQA accreditation, Federal/State regulations, licensing or reviewing agency requirements; liaison for Quality Improvement Committees. We recruit, retain, and advance associates with diverse backgrounds, skills, and talents equitably at all levels.

Primary Duties and Responsibilities

• Actively participates in the development and completion of the annual Health Education Plan and Health Education Appraisal, annual QI Plan and QI Appraisal. Prepares annual Performance Improvement Plan (PIP), and Quality Improvement Activity Analysis (QIA\'s).
• Analyzes the Provider Satisfaction Survey and CAHPS survey results and report findings to QI/UM committee.
• Assists with development and maintenance of MedStar Family Choice\'s Quality Improvement Program via input with the annual Quality Improvement plan and appraisal.
• Attends and contributes content to the monthly Quality Improvement staff meetings. Assists the Quality Improvement Manager in maintaining accurate and thorough meeting minutes. Attends the Quality Improvement and Utilization Management Committee (QI/UM) meetings and other meetings as directed.
• Contributes to member and provider newsletters as well as MFC website content.
• Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
• Serves as a liaison between MFC and the Maryland Department of Health\'s EPSDT nurse in order to disseminate updated EPSDT regulations to the Provider Relations department and our providers. Coordinate with the state to ensure the EPSDT auditors have access to MFC medical records. Analyzes the EPSDT survey results and report findings to QI/UM committee.
• Follows the established protocol for reporting any quality issues identified.
• Subject Matter Expert for COMAR regulations and Systems Performance Review activities and actively participates in evaluating MedStar Family Choice\'s compliance with the regulations and standards. Provides cross departmental input in gathering required materials in support of SPR activities and follows up on audit findings. Uploads all required materials into the Maryland Department Health\'s online portal.
• Actively participates in the HEDIS audit by attending/leading HEDIS trainings, gathering required records, abstracting pertinent medical record data, entering data into the HEDIS software database, and performing peer audits. Attend HEDIS pro-Active meetings and remain current on annual updates.
• Participates in the design and implementation of multidisciplinary quality improvement projects as determined by MFC.
• Collaborates with the Quality Improvement Manager to ensure that all components of the QI Standards for NCQA accreditation are met. Remain current on annual updates.
• Investigates quality of care events for MFC members, summarizes findings, and reports cases to the MFC Quality of Care Peer Review Committee (QOC). Organize and attend monthly QOC meetings, maintain confidential meeting minutes, and report the QOC activities to the QI/UM committee. Ensure that all applicable cases are forwarded to the Credentialing Department for tracking and trending.
• Investigates quality of care events for MedStar Medicare Choice members, summarize findings, and collaborate on cases with the MedStar Health Plans Medical Director. Report quality of care activities to the Medicare QIC quarterly meetings. Function as a liaison to the State of Maryland and the Maryland Department of Health for quality improvement matters on an as needed basis.
• Provides feedback to healthcare providers to apprise them of services that are still needed for patients in order for them to be compliant. Works directly with provider offices to inform them of their Quality and performance on HEDIS measures and educates them on opportunities for improvement. Travel to offices may be required.
• Provides oversight to assigned delegated entities and reports finding to the QI/UM committee. Evaluates the annual plans, appraisal, quarterly reports, claims and other issues as they arise. As issues arise, assists with the development of a Corrective Action Plan.
• Revises QI policies and procedures annually.
• Performs other duties as assigned.

Minimum Qualifications
Education

• Bachelor\'s degree in healthcare field (BSN) preferred

Experience

• 3-4 years Healthcare experience required and
• Quality improvement experience preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in Maryland. required and
• CPHQ - Certified Professional in Healthcare Quality CPHQ preferred

Knowledge, Skills, and Abilities

• Effective verbal and written communication skills.
• Ability to follow verbal and written instructions.
• High degree of computer proficiency.
• Ability to establish priorities, self-motivated, works independently and follow instructions with supervision.

Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:

• Strong emphasis on teamwork\xe2\x80\x94our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
• Strategic focus on equity, inclusion, & diversity\xe2\x80\x94we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
• Comprehensive total rewards package\xe2\x80\x94including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
• More career opportunities closer to home\xe2\x80\x94as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.

About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It\xe2\x80\x99s how we treat people.

MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health\'s policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.

Medstar Health