Corporate Quality Specialist


Community Health Group is a locally based non-profit health plan that ensures access to high quality, culturally sensitive health care for underserved communities throughout San Diego County. We treat our 300-member, multi-lingual staff like family, encouraging an atmosphere of collaborative teamwork, continuous learning, personal growth, and promotion from within. Recognized as one of the Top Workplaces in San Diego, CHG offers its employees such benefits as tuition reimbursement, a meditation room and yoga classes, a monthly Breakfast With The CEO, and memorable events throughout the year. 

We know that by serving our employees well, they, in turn, will better serve our nearly 300,000+ membership. We have been recognized consistently for the excellence and sensitivity of our customer service by members, physicians, vendors, and a full range of health care providers. We are accredited by the National Committee for Quality Assurance and proud of our continuing company-wide Quality Initiatives.

We are currently recruiting for:

Corporate Quality Specialist

POSITION SUMMARY

Conducts Physical Accessibility Review (PARS), conducts mental health facility reviews, and assists in requesting, tracking, and obtaining medical records and provider statements for potential quality issue (PQI) resolution.  Assists in the logging and receipt of corrective action plans, medical records, and other requested material from providers to meet internal, external, and regulatory timelines and standards.  This include assisting with the preparation of reports and other documents; summarizing, documenting and distributing the meeting materials; ensuring follow-through on committee action items and maintaining appropriate records.

 

COMPLIANCE WITH REGULATIONS:

Works closely with all departments necessary to ensure that the processes, programs and services are accomplished in a timely and efficient manner in accordance with CHG policies and procedures, accreditation standards, and in compliance with applicable state and federal regulations including CMS, DHCS and DMHC.

 

RESPONSIBILITIES

  • Conducts PARS at provider sites under the direction of the Quality Improvement Nurse, including scheduling review with the provider, recording review in the shared facility review database, and recording review information in internal logs.

  • Maintains accurate records and files of facility site reviews and PARS, PQI and quality of care grievance cases, and scans, transfers, and archives documents per department protocols.

  • Works closely with the clinical team to facilitate obtaining information, corrective action plans, and required follow-up when needed.  Tracks the request, receipt, and review of requested records, corrective action plans, and other material to support quality reviews of PQIs, quality-related grievances, site and facility reviews, and sentinel events.

  • Facilitates the production of timely and accurate reports relating to quality improvement activities.

  • Assists the department in being “audit ready” at all times.

  • Develops and fosters good working relationships with providers and their staff.

  • Assists with administrative duties as assigned.

  • Assists in resolving problems relating to perceived quality of care and maintains confidentiality.

  • Contributes to the team effort by attending department meetings; giving and receiving feedback; accomplishing related results as needed; assisting clinical staff in policy development and periodic policy review.

  • Performs other duties as assigned or requested.

     

     

    EDUCATION:

  • High school diploma.

  • Medical terminology.

  • Bachelor’s Degree in a health care related field preferred.

     

    EXPERIENCE/SKILLS:                                                    

  • 2 years clerical and customer service experience in medical field.

  • Strong working knowledge of Microsoft Office (Outlook, Word, Excel, PowerPoint, Visio) and ability to use other systems, as required.

  • Excellent customer service and communication skills (verbal and in writing).

  • Detail-oriented and organize work effectively.

  • Ability to interface with all levels of staff and outside agencies

  • Exercise good judgment and problem solving skills.

     

    PHYSICAL REQUIREMENTS:

  • Prolonged sitting, data entry and telephone use.

  • Driving within San Diego County.  Current driver’s license, car insurance and reliable vehicle required.

  • May be required to work evenings and/or weekends.