QI Coordinator

To provide efficient and effective administrative, clerical, data entry and proactive support to the operations of Quality Improvement Department's activities and to other departments.

Essential Functions & Responsibilities

  • Supports implementation, administration and monitoring of specific Quality Improvement (QI) Management activities.
  • Provides Quality Improvement information and education as needed within the organization.
  • Provides comprehensive administrative support to the Quality Management Program.
  • Assists with implementation and compliance of AHCA Medicaid regulations, NCQA standards and contracted Client's QI requirements.
  • Organizes multiple quarterly quality committee meetings with: annual scheduling of committees, participant management and documents, agenda creation, organization of electronic presentations for participating departments, room preparation, preparing electronic meeting minutes and electronically archiving minutes and documents.
  • Assists with pre and annual delegation oversight activities and the monitoring of quarterly and annual reports from delegated entities to be presented to various Quality Improvement Committee.
  • Develops and maintains positive interface relationships with all vendors, contractors, delegated entities and organizational staff.
  • Develops and maintains a process for timely follow up activities for all clinical and services quality care issues brought to the QI Department.
  • Maintains Quality Improvement Referral (QIR) log, file organization, correspondence and follow-up.
  • Monitor electronic files (SharePoint Program) for annual updating activities to maintain the validity and accuracy of the QI Policy and Procedures.
  • Participate in all quality audits with providers, contracted Client's, delegated entities, accreditation and regulatory bodies, as applicable.
  • Provides QI support to the Utilization Management and Credentialing Department on an as needed basis.
  • Provides support to new business projects assigned to the Quality Management Department and/or Credentialing Department.
  • Ensures compliance with and/or adheres to Company HIPAA, Fraud, Waste and Abuse and Confidentiality policies and procedures.
  • Ensures the confidentiality and integrity of data entered into the HS1 systems and/or database.
  • Supports and complies with the HS1 Mission Statement, Policy/Procedure/Processes, confidentiality, conflict of interest and H.R. policies.
  • Ability to safely and successfully perform essential job functions consistent with the ADA, FMLA, and other federal, state, and local standards, including meeting qualitative and/or quantitative productivity standards.
  • Ability to maintain reasonably regular, punctual attendance consistent with the ADA,
  • Ability to come to work and work the regular schedule and shift for the position.

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Education and/or Experience

  • Minimum of two (2) years in the Managed Care industry.
  • Quality Improvement experience a plus.
  • Associate's degree (A. A.) or equivalent from two-year College or technical school preferred.

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