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Quality Specialist in Nashville, TN at KEPRO

Date Posted: 7/26/2018

Job Snapshot

Job Description

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization. We are a leading quality improvement and care management organization. We offer innovative and outcomes-focused solutions to reduce the unnecessary use of health care resources and optimize the quality of care for public and commercial clients. KEPRO’s tailored programs maximize members’ quality of life, and realize greater cost savings for members and clients alike. KEPRO is on a journey to transform medical management and to develop customized solutions tailored to our client’s specific business requirements, while improving the quality of life for patients, reducing costs, and achieving return on investments for our clients. Our approach to medical management is holistic and compassionate and is coordinated around a patient’s entire healthcare experience.

Quality Specialist

Summary Description

Technical and administrative function in the development, implementation and coordination of testing and quality assurance to support the program or contract.  Identifies/plans/coordinates/implements quality improvement projects using knowledge of performance improvement strategies, principles, methodology, techniques and data analysis. Uses measurable indicators and outcome measurements to determine whether the desired organizational results are achieved.

 

Accountabilities / Essential Functions

  • Maintains current information on clinical practice guidelines, health tech assessments, research studies, policies and recommendations for expert medical testimony.
  • Maintains a policy library.
  • Assists client/customer with issues relating to policy implementation, processes and appeals and appeals decisions.
  • Ongoing planning, development, and maintenance of internal monitoring program for review activities performed by clinical review team. 
  • Conducts time studies for staffing recommendations.
  • Develops, coordinates and implements testing and quality assurance measures and activities.
  • Participates in developing and monitoring testing and quality assurance policies and plans.
  • Assesses potential problems and recommends corrective actions to resolve or mitigate associated risks.
  • Monitors the implementation of testing and quality assurance policies, processes and procedures to ensure uniform application across the board.
  • Prepares and submits reports and/or deliverables timely as required.
  • Other duties as assigned

The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time.

Qualifications

  • Bachelor’s degree or equivalent required.
  • Applicable experience in quality improvement is preferred. 

Skills, Knowledge Abilities (SKA)             

  • Knowledge of current principles and practices required to develop and implement testing and quality assurance measures.
  • Knowledge of the capabilities and requirements of current testing and quality assurance methodologies, equipment, and software.
  • Knowledge of the principles and practices of project management required for system testing, quality assurance and risk analysis assessments.
  • Knowledge of the principles and techniques of computer system testing, quality assurance and risk analysis documentation.
  • Ability to organize and evaluate testing and quality assurance activities to coordinate operational and monitoring procedures for improved service delivery or problem resolution.
  • Ability to provide technical assistance to staff on testing, quality assurance and risk analysis measures and standards.
  • Ability to establish and maintain effective working relationships with customer, vendors, and others.
  • Ability to understand and apply research and evaluation methodologies for testing, quality assurance and risk analysis decision making.
  • Ability to prepare and present findings and to provide support and guidance concerning
  • Excellent communication- (verbal and written)
  • Experience identifying organizational needs and recommending the appropriate improvements to increase organizational effectiveness.

Experience

  • 3 years’ experience in the healthcare industry.
  • 1 to 2 years of continuous quality improvement experience.

Mental and Physical Requirements        

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations will be made as required by law in an attempt to enable an individual with a disability to perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time; key and/or control objects; interact extensively with internal and external customers; occasionally lift and/or move objects weighing up to 10 pounds; and occasionally travel within the state.

KEPRO offers challenging careers, excellent benefits and opportunities for advancement.  For consideration, please submit resume and cover letter with salary requirements. Only those candidates identified for an interview will be contacted. No Phone Calls Please.  Visit our website at www.kepro.com for more information on the KEPRO Family of Companies.

EOE AA M/F/Vet/Disability

KEPRO is an E-Verify employer. E-Verify is an internet based system operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA) that allows participating employers to electronically verify the employment eligibility of their newly hired employees in the United States.