Coor Quality CI Program at Wellstar Health Systems in Marietta, Georgia

Job Description:

Facility: 1800 Parkway Center


*** Candidates in West GA area (Lagrange, Griffin, Peachtree City) are strongly encouraged to apply as frequent travel to this area is required! ***





Job Summary:

The Quality Coordinator, Clinical Integration Program is a position supporting both the efforts of the WellStar Clinical Partners and the efforts of the WCP Accountable Care Organization. This position reports to the Manager, Clinical Integration (CI) Program.


The Quality Coordinator supports the quality and process improvement strategies and tactics implemented across the WCP network and plays a key role in helping to systematically monitor the quality, safety, and outcome of patient care for employed and affiliate physicians. The Quality Coordinator serves as the primary contact for and subject matter expert to the physician members of the Clinical Integration (CI) program as well as their practice staff. He/she will also serve as the liaison between the WellStar Clinical Partners organization, the Accountable Care Organization members, WCP Quality Committee and Payors with whom we have valuebased contracts.


In this role, the individual is responsible for the overall analysis and development of action plans for clinical, quality, utilization, and process metrics, as well as the cost of care reduction. Specifically, he/she will review regional and practice level quality reports, analyze data, conduct root cause analysis, prepare summary reports with improvement recommendations, and monitor progress of assigned practice monthly. In addition, he/she will provide guidance, education, and support to physicians, advanced practice providers and practice staff regarding quality initiatives.


As a liaison, the individual in this role must be able to communicate effectively and with a high level of regard for leadership positions and physician partners of WCP and Wellstar Health System. He/she will craft key messages in a manner that gains consensus and thoroughly explains the purpose of the information. The Quality Coordinator will prepare and facilitate Town Hall meetings in collaboration with the physician chair and WCP Director.


The Quality Coordinator will be responsible for attending WCP Quality Committee meetings and assigned payer meetings. He/she must be able to interpret requests for clinical quality and healthcare cost data and create actionable strategies and summary reports. The Quality Coordinator will also be responsible for the specific area(s) of expertise to drive performance and educate providers based on value-based payer contractual requirements. He/she will also serve as a resource to existing or potential physician participants and will be responsible for onboarding/orientation for new physicians.


The Coordinator Quality CI Program must maintain current awareness of best practices related to inpatient, ambulatory, and emergency department processes and quality policies and protocols related to WCP program operations. This individual will be a key participant in the transformation of WellStar into a preeminent clinically integrated Health System.




Core Responsibilities and Essential Functions:



40% Coordinate the quality improvement strategies of Wellstar Clinical Partners (WCP) and ACO (Accountable Care Organization) providers


• Act as primary quality liaison for ACO and WCP leaders, providers, and staff members


• Subject matter expert regarding ambulatory quality metrics


• Maintains current quality measure knowledge base, including ACO, PQRS, HEDIS, and other ambulatory measures


• Travels to provider (ACO and WCP employed and affiliate) to provide education, audits, and reports regarding quality metrics


• Monitor the quality measures and, in collaboration with providers and/or practices, prioritizes interventions to improve performance


• Collaborate with key leaders of the ACO and WCP Quality Committee to ensure that care systems and programs are in place to deliver value-based care to beneficiaries


• Stay current on quality measure regulations, updates, additions, changes, and deletions


• Develop and deliver training programs on ACO and WCP quality metrics and initiatives for providers and staff


• Collaborate with Clinical Informatics team to maximize Epic EHR to efficiently document quality measures


• Collaborate with affiliate providers to enhance quality metric documentation on disparate EHR's.


• Audit affiliate office records periodically and report results to ACO and compliance leadership


25% Coordinate Quality Data Reporting


• Develop quality and utilization reports and presentations to convey performance against metrics.


• Conduct payor chart reviews to identify trends and close data gaps


• Work with WCP leadership to identify areas for improvement in terms of cost, quality and utilization of services.


• Identify enhancements for CI information technology to support the CI program and interfaces with IT, quality department and physician offices to support accurate documentation for transmission to IT vendor.


• Serve as a subject matter expert on: o ACO and WCP quality metrics o Medicare Advantage quality metrics (e.g. CMS Stars, HEDIS) o Ambulatory metrics related to the quality initiatives of ACO and WCP providers


• Provide leadership in the development of systems, reports, and programs that will maximize performance in all related program metrics, including the ACO, Population Health, WCP and other departments as needed


• Collaborate with WMG Clinical Informatics and Epic Ambulatory teams to evaluate Epic documentation regarding ACO quality metrics


20% Monitor approved quality initiatives for updates and changes as defined by quality agencies on an ongoing basis.


• Track changes and approvals to maintain up to-date data files and report cards.


• Implement and track quality-based projects, monitors data across the CI network, and maintains an up to-date data file for report cards.


• Lead evaluation of the CI program initiatives for effectiveness and manages annual processes to access and improve the CI program. Implements and tracks quality-based projects.


15% Work with WCP leadership to identify areas for improvement in terms of cost, quality and utilization of services


• Identify enhancements for CI information technology to support the CI program and interfaces with IT, quality department, and physician offices to support accurate documentation for transmission to IT vendor.


• Provide oversight of collaborative initiatives and educational offerings and ensures that appropriate leaders and staff are aware of relevant events


• Attend relevant collaborative offerings, to include WCP Quality Committee meetings and assigned payer meetings


• Investigate best practices for quality improvement among collaborating members.


• Support the efforts of Population Health to improve quality and coordination of care with WCP ACO and managed care providers


• Provide education and support regarding quality initiatives and measures to members of health care teams including physicians, nurses, case managers, home health staff, and medical assistants


• Collaborate with Population Health and clinical care teams to improve the quality of care and appropriately lower the cost of care delivered to ACO and WCP beneficiaries


• Advise Population Health and managed care leaders regarding technical specifications of quality measures for disparate ambulatory and/or managed care programs


Performs other duties as assigned


Complies with all Wellstar Health System policies, standards of work, and code of conduct.




Required Minimum Education:



Bachelor's degree in health science OR Bachelors Nursing OR Bachelor of Business Administration/Management Required


Master's Degree Preferred




Required Minimum License(s) and Certification(s):



All certifications are required upon hire unless otherwise stated.




Additional License(s) and Certification(s):

If RN or Clinical Licensure, maintain that licensure.




Required Minimum Experience:



Minimum 5 years of experience in a health care setting, including skill with quality reporting and analysis required and demonstrable understanding of healthcare compliance and/or regulatory reporting requirements.


Minimum 10 years of clinical experience as Registered Nurse with quality focus


preferred.




Required Minimum Skills:



Strong analytical, problem solving and decision-making skills.
Excellent organizational skills and the ability to work within all levels of the organization.