Quality Review Coordinator - Morrisville, United States - Alliance

Description

This position will plan, facilitate, document, and execute projects as directed by the Quality Improvement Manager that relate to business transformation, continuous improvement activities throughout the organization to improve/streamline processes, perform data analysis, develop, and promote effective design/structure, drive efficiency, measures, clinical and operational processes, and/or savings. This position will apply project management, facilitation, statistical techniques application, root cause analysis, Lean Six Sigma and continuous improvement tools, process evaluation, research and report writing, strategic organization direction, and other improvement tools and techniques to drive, track and evaluate interventions (along with other approaches as determined by the agency and other regulatory entities.

This is a full-time remote opportunity. The selected candidate must reside in North Carolina and be available to come into the Home office (Morrisville, NC) for onsite meetings and trainings as needed.

Responsibilities & Duties

Perform and Manage Continuous Improvement and Project Management Functions of Interdepartmental Projects

• Using a data driven approach, lead and facilitate the development and design of multiple Quality Performance Improvement Charters and Projects (PIPs) based on sound and valid statistical analysis (ex. baseline determination, trends, targets, demographic, inequities, root cause problem solving, process capabilities, gap analysis etc.), research methods and statistical techniques as per US Department of Health & Human Services, Centers for Medicare & Medicaid Services (CMS), NCQA, Tailored Plan, and other agency and accredited entities guidelines for performance improvement projects
• PIPs reports must include a strong project management and continuous improvement approach, high quality research study and statistical analysis (including but not limited to: sufficient probability sampling, measurement of baseline data, sophisticated data analysis, timely and relevant implementation of improvement activities, interpretation of results, institution of a control (quality assurance) system to ensure improvement continues, thorough barrier analysis if improvements are not achieved
• Prepare and present project reports to the Project Team as well as other persons, committees, and teams across the agency
• Display a working knowledge of operational approach, continuous improvement tools, lean methodology and relevant/positive execution of tasks
• Conduct meetings and assist with committee facilitation with team members and other entities (both internal and external) to discuss the status of the project and to make necessary adjustments towards improvement approach and strategies to achieve the desired results
• Using a data driven approach, motivate and influence staff (both assigned to the project and/or not a member of the core group) to accomplish task(s) successfully by using statistics, data evaluation, organizational development, lean six sigma tools, sociology, economics, public health, business administration, psychology, or related social science, to name a few
• Perform internal and external research, to include collaborating with clinical staff (RN, Pharmacists, MDs and LCSW input where clinical elements are involved, collaborate with specific project area stakeholders to offer process needs identification and targeted interventions
• Identify and promptly address any problems that may pose a risk to achieving the desired outcome of the project within the time and budget constraints
• Create and deliver presentations to variety of stakeholders as needed
• Ensure adequate documentation and lean methodology to support findings and recommendations in line with CMS guidelines for performance improvement projects and focused studies. Guidelines require sophisticated analysis of initial and repeat measures (establishment of measures if none are currently present), root cause problem solving, realistic targets for measures, and analysis of whether intervention successfully resolved problem. Additionally, analyses may include sophisticated calculations of statistical significance and statistical hypothesis testing
• Design and implement research evaluations of shorter-term and focused studies, collaborating with a process improvement team, that address immediate concerns, identifies root causes of concerns, implements solutions, writes summary of findings/recommendations, and institutes a control (quality assurance) system for the unit performing the work to ensure improvement continues; and analyzes impact of system on sustaining improvement (in adherence to CMS guidelines for focused studies)
• Participate in internal committees as a quality improvement and research/statistical analysis subject matter expert; creates and delivers presentations that meet professional, ethical, and analytic standards for clarity and completeness; tracks implementation of solutions; and creates quality assurance systems to effectively sustain improvement
• Lead other evaluation/research projects as determined by Supervisor
• Create professional charts, data reports following the sound and rigorous standards for writing scientific reports outlined in the American Psychological Association (APA) Publication Manual, and presentations related to assigned data/evaluation/research projects
• Develop and maintains professional and positive working relationships with all Alliance departments, contracted network providers, and consumers/family members and other stakeholders to fulfill the mission, vision, and goals of the Quality Management Department, to successfully manage cross-functional process improvement teams
• Serve as process improvement lead and facilitator by defining areas of opportunity, assembling team of interdepartmental experts ( required for effective brainstorming, intervention establishment, action items tracking, effectiveness determination and documentation of measures), measuring baseline data, analyzing root cause of problem, facilitating process to identify solution, and creating a quality assurance system for the unit performing the work to sustain improvement, and analyzing the impact of the systems on maintaining improvement related to quality management accreditation standards
• Assist in developing and delivering instructional materials and providing technical assistance related to evaluation studies, quality reviews, data analysis, and reporting, as requested
• Assist in the development of MCO standards for service monitoring, quality improvement, and evaluation of the delivery of services to consumers and families
• Serve as team lead for chart or clinical reviews of consumer information to conduct analysis of program effectiveness or to identify opportunities for process or quality improvement
• Demonstrate strong people engagement skills that lead to positive relationships and structural outcomes
• Other job-related duties as assigned

Identify Root Causes of Quality Issues

• Leverage lean concepts to identify value added and nonvalue-added elements and activities: while using quality tools to identify failure points in processes and establish clean value-added adjustments to move forward
• Conduct process mapping exercises, root cause analysis, effective data collection plans design, understand sources of performance variation, and communicate these principles effectively to a broad audience
• Perform analysis and define success targets based on internal and external requirements as well a well thought out business case

Effectively Measure the Key Output Variables

• Conduct statistical analysis of initial and repeat measures to evaluate efficacy of interventions and to improve approach to successfully resolving root cause as needed
• Design appropriate sampling plans and measurement systems to assess process capability and overall system performance
• Evaluate validity and accuracy of data sources to draw appropriate conclusions

Analyze Changes in Performance

• Perform any required data analysis to evaluate performance linkage and gaps
• Prepare comprehensive reports to ensuring adequate documentation and methodology to support findings and recommendations

Design and Lead the Implementation of Effective Interventions

• Generate and evaluate solution ideas using Lean methodologies to reduce and prevent waste
• Develop plans for implementing proposed improvements, including conducting pilot tests or simulations, and evaluate results to select the optimum solution

Develop a Sustainable Monitoring Process and Procedure

• Verify reduction in failures due to the targeted root cause
• Ensure that all staff involved in the improvement efforts are trained to sustain the improvements and have a robust monitoring plan to detect future performance issues

Complete Reports

• Demonstrate strong report composition skills
• Compose and complete accurate reports/summaries detailing bodies of work designed for accreditation and other business reviews

Minimum Requirements

Education & Experience

Required:

Bachelor's degree in project management, lean six sigma, statistics coursework sociology, economics, psychology or related social science, research methodology, computer science, and/or other coursework directly related to the work to be performed, and two years of progressively responsible experience in gathering, editing, and analyzing data for social and economic research, preferably including experience in the particular program area; or an equivalent combination of education and experience. Microsoft Office Products at intermediate level.

Preferred:

Master's Degree, and at least five years of experience in the field of project management/facilitation, mental health, developmental disabilities or substance abuse is preferred. Experience or classwork in data analysis and research evaluation or statistics is required. Preference for a professional with a project management/facilitation, lean, statistics, and program evaluation or quality management experience. Experience in any of the following areas would be valuable for this employee: Public speaking, mediation, report writing.

Knowledge, Skills, & Abilities

• Exceptional interpersonal skills, excellent teambuilding skills, and highly effective communication ability
• Problem solving and conflict resolution skills are essential
• Strong written, documentation, and analytical skills are required
• Ability to apply statistical principles and valid research methods in the evaluation of problems, along with conceptual and organizational skills to abstract the data
• A strong knowledge of state and federal rules, requirements and practices related to the service continuum in North Carolina is imperative
• Strong clinical skills and a knowledge of best and promising practices for behavioral health and/or intellectual/developmental disabilities, along with proficiency advanced functions of Microsoft Office Excel are required
• Advanced skills in Word, PowerPoint, SPSS, and Survey Monkey (or other online survey tool) are preferred

Salary Range

$58,480 - $74,562/Annually

Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

An excellent fringe benefit package accompanies the salary, which includes:

• Medical, Dental, Vision, Life, Long and Short-Term Disability
• Generous retirement savings plan
• Flexible work schedules including hybrid/remote options
• Paid time off including vacation, sick leave, holiday, management leave
• Dress flexibility