Performance Improvement & Quality Assurance RN

Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:

The Process Improvement & Quality Assurance Program (PIQA) supports and educates Driscoll Health Plan (DHP) Population Health staff. The PIQA program is designed as an integral component of a proactive and progressive program to maintain compliance with Federal, State, Regulatory, and accrediting body standards. The PIQA Specialist uses tools to compare current work with evidence-based population health standards of practice, and Service Coordination strategies as staff complete Service Assessment Instruments (SAI), Individual Service Plans (ISP) and various mini-assessments used in promoting holistic care for DHP members. The program consists of chart and record reviews for early identification and intervention when irregularities are identified in documentation. Recorded telephonic interactions between Population Health staff, and stakeholders are also monitored for regulatory compliance. The goal of the program is to verify accuracy and proactively retrain staff who may need redirection.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The PIQA Specialist applies expertise in data analysis to give insight into operational PH measurement of contractually required documentation. The incumbent will engage with clinical teams composed of PH leadership, managers, and front-line staff to improve outcomes and PH Operations. This should be accomplished through daily review and analysis, collaborating with colleagues, actively participating to effectively improve documentation. To perform this job, an individual must successfully perform each essential duty. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Always maintains utmost level of confidentiality.
• Adheres to Health System and Health Plan policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Demonstrates a high degree of independence, flexibility, initiative, and commitment.
• Identifies documentation discrepancies, gathers, compiles, and evaluates data from various sources, and audits for reporting to internal leadership and external agencies, (e.g., PH and QM Committees, HHSC Performance Improvement Projects (PIP), HHSC initiatives and PH Operations Audits, etc.
• Assists in data capture, analyzing, identifying trends/concerns, and preparing recommendations for improvements as indicated in analyzed data.
• Performs internal PH Operations audits and/or trend assessments to identify opportunities for improvement
• Assist in the evaluation of the effectiveness of PH Operations projects/initiatives within DHP in conjunction with Program and work plans.
• Performs PH activity audits, makes recommendations as needed.
• Provides training related to relevant PH Operations leadership and management regarding processes and initiatives for DHP staff.
• Ensures the integrity of project data, including data extraction, processing, storage, manipulation, analysis, and distribution.
• Works with management to develop statistical analysis that address proposed projects and analyzes data using basic statistical methods, interprets results and provides written summaries of analyses on short notice and with timely turnarounds.
• Maintain, generate, and participate in the development of PH Operations metrics dashboards.
• Serves as an expert on clinical data abstraction/interpretation
• Performs other duties as requested.

EDUCATION AND/OR EXPERIENCE:

• Minimum- Associate’s degree in nursing. 3-5 years related experience and/or training; or equivalent combination of education and experience.
• Previous experience with health plan or healthcare required.
• Previous experience with STAR Kids STAR Medicaid preferred.
• Proficiency in Microsoft Office suite including Word, PowerPoint, Excel, Visio

CERTIFICATES, LICENSES, REGISTRATIONS.

Current unrestricted Registered Nurse Licensure in the state of Texas