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MLTC Clinical Quality Improvement Specialist

Company: Metroplus Health Plan
Location: New York
Posted on: December 7, 2017

Job Description:

MLTC Clinical Quality Improvement Specialist Job Ref: 31962 Category: Quality Assurance Department: MANAGED LONG TERM CARE Location: New York, NY Job Type: Regular Employment Type: Full-Time Hire In Rate: $90,000.00 Salary Range: $90,000.00 - $90,000.00 Marketing StatementMetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus' network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. Job Description

  • Review clinical documentation in order to ensure that all components of the UAS assessment meets quality standards and accuracy following the Company's policies and State regulations.
  • Compare UAS, Tasking Tool to ensure correlation
  • Assist the Care Manager, as needed, to determine areas that require immediate remediation and assist in resolving inconsistencies.
  • Prepare various reports and correspondences as well as provide summary report's to highlight key findings for implementation of performance improvement plans.
  • Maintain a tracking tool that will log unacceptable/inconsistences/and errors observed during quality reviews.
  • Communicate with RN assessors and contracted vendors inconsistencies and changes needed in the review
  • Work with management team to identify areas of continuing education to or assessment nurses and contracted vendors of our policies and procedures for UAS and Tasking Tool assessment.
  • The Analyst will assess current quality metrics and identify areas for quality improvement based on quality measures identified by NYS which directly affects a Plan's quality incentive. The incumbent will identify inter-rater of reliability scales and examine the intra-rater reliability upon analysis of the UAS-NY data.
  • Provide feedback to the management team regarding the field Assessors' documentation as well as provide guides towards documentation improvement and expectations
  • Act as a liaison between Field Nurses and Care Managers and provide Management with feedback on documentation and improvement and expectations.
  • Assist with special projects as assigned to meet departmental goals and policies
  • Oversight of vendor dashboards for quality initiatives
  • Weekly report to management on UAS reviews. Minimum Qualifications
    • Associate's degree from an accredited institution.
    • NYS Registered Nurse (RN) license.
    • Experience in medical records review, utilization and case management in a clinical practice or managed care organization.
    • Experience analyzing various types of data and processes in a versatile manner including ability to present findings and make recommendations.
    • Experience with a corporate email system (Microsoft Outlook) including using and sharing calendar rights, Microsoft Word and electronic Patient Health Information (PHI) database usage (medical records database).
    • Microsoft Excel skills with the ability to edit, search, sort/filter, format/use styles, create tables, calculate data using functions and formulas and create/use PivotTables for analyzing data.
    • Valid NYS driver's license or NYS non-driver's license ID (DMV Identification). If residing outside of NYS, candidate must obtain a NYS non-driver's ID before commencement of employment.
    • State registration with the Uniform Assessment System (UAS) for long-term care in NY State is required to access for training, testing and system usage. Upon completion of UAS training, the State will administer testing online. If a passing score is not achieved, the State will allow the individual to retake the test once. The UAS access is a necessity for this position, so employment is contingent on acceptance and continued authorization by the State to have UAS access.
    • Proficiency with healthcare terminology such as ICD-9/10 codes, medical abbreviations Professional Competencies:
      • Integrity and Trust
      • Customer Focus
      • Functional/Technical skills
      • Written/Oral Communication How To ApplyIf you wish to apply for this position, please apply online by clicking the "Apply Now" button or forward your resume, noting the above Job ID #, to: MetroPlus Health Plan Human Resources Department 160 Water Street 8th Floor New York, NY 10038 Attn: Recruitment Unit This is position is classified as a managerial title, in addition to a variety options for Health Benefits through MetroPlus, managerial employees receive vision, dental, gym reimbursement and life insurance benefits through the Management Benefits fund of the City of New York. Please view the benefits page for more detailed information.

        Keywords: Metroplus Health Plan, New York, MLTC Clinical Quality Improvement Specialist, Healthcare, New York, New York

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