Clinical Quality Analyst - FT
SUMMARY: The Clinical Quality Analyst reports to the Quality Director. Under general supervision and within GPRMC established policies and procedures, assists with the coordination and implementation of tasks associated with clinical quality data abstraction support for public reporting through the national quality initiatives and clinical registry reporting programs for GPRMC. Accesses medical records information for the purposes of supporting clinical abstraction, provides support to abstraction services professionals and monitors project timelines, data submission due dates for The Joint Commission(TJC)/National Hospital Quality Measures (ORYX) requirements, Centers for Medicare and Medicaid (CMS), clinical registries, and performs follow-up duties as required to ensure timely and complete data submission. Notifies the Quality Director when issues arise and identifies opportunities where corrective action may be needed to ensure completion and integrity of data submission. Monitors changes and additions to ensure measurement standards of Hospital quality program, The Joint Commission (TJC), Centers for Medicare and Medicaid (CMS) and other regulatory agency requirements are met. Serves as liaison between clinical staff and Quality Director as needed.
- Accesses vendor abstraction tools (including reporting options) and the clinical warehouse for data reporting to ensure accuracy of data reports through rate verification during preview periods and the validation process. Submits corrections or appeals as directed.
- Supports the clinical data abstraction and management process for clinical quality measures, i.e. vendor issues and deadlines, system maintenance, training and scheduling, monitoring data for accuracy and verification. Completes and supports work assigned to the project team for specific task assignments including data management, medical record coordination, and abstraction, in accordance with HIPAA regulations.
- Serves as a resource for internal customers to understand data collection specifications, documentation requirements, data interpretation to facilitate improvement activities. Participates in group and project activities for process improvement as directed.
- Assist to review data integrity and ensure that all abstraction work is accurate and competent, and communicates outliers, issues, or opportunities to Quality Director. May assist in compiling data and auditing records to ensure internal accuracy of information and/or review results of outsourced vendor services. Supports completion, integrity and accuracy of data submissions as guided by Quality Director.
- Assists in clinical record review for mortality measures, ongoing physician performance evaluations, and other performance improvement projects as needed.
- Assists in follow-up discharge phone calls to evaluate patient experience. Makes referrals to appropriate departments if needed.
- Assists with tracking of ongoing review of electronic order sets. Assists with making edits as needed and according to applicable policy and procedures.
- Notifies Quality Director of changes in trends or results associated with performance levels and/or compliance with evidenced-based care in real-time.
- Assists in identifying gaps in documentation that impacts accuracy or measured performance on required measures of performance. Aligns goals of abstraction services with upstream documentation and clinical services workflows, identifies gaps as opportunities for improvement.
- Facilitates and coaches teams working to improve performance. Coordinates and supports the implementation of improvement tactics in alignment with organizational priorities.
- Notifies the Quality Director when issues arise and takes corrective action as needed.
- Performs other duties as assigned.
EDUCATION: Associate degree or bachelor’s degree or equivalent in nursing or other healthcare related field is required.
EXPERIENCE: Two to five years of relevant clinical hospital experience. Ability to maneuver through Meditech Magic EHR. Knowledge of problems, activities and causes related to provision of clinical care and of methods of quality assessment. Knowledge of federal, state, and voluntary quality management regulations and standards. Must possess excellent verbal and written skills, ability to be self-directed and obtain current quality initiative and specification details from federal and state manuals. Expertise with access and understanding of data sources such as medical records, department/service specific data, and various manual and automated data systems. Demonstrates technical knowledge of the Specification Manual for National Hospital Quality Measures and other data specification manuals as relevant to assigned areas of abstraction responsibility. Proficient with Word, Excel, and PowerPoint applications at a minimum.
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS: Work is performed in a typical office setting, requiring extensive periods of sitting, with arms extended as well as walking and standing.