Fallon Health Clinical Quality Management and Analyst Nurse - MLTC - Fallon Health Weinberg in Amherst, NY, New York
About Fallon Health Weinberg - MLTC:
Fallon Health Weinberg-MLTC is a partnership between Fallon Health of Massachusetts and Weinberg Campus of Erie County, New York. Fallon Health Weinberg a Managed Long-Term Care (MLTC) is a plan to serve the health needs of dual-eligible residents of the Western New York counties of Erie and Niagara. Fallon Health Weinberg expands the choices that residents of Erie and Niagara Counties have when it comes to high quality, affordable health care.
Brief Summary of Purpose:
Responsible for supervising the quality and risk management activities of the MLTC Program. Efforts are focused on the development of systems for collection of clinical and other quality data, analysis and interpretation of data, and implementation and monitoring of corrective action plans. Provides clinical expertise and technical support for quality initiatives. Develops and maintains clinical quality databases. Develops reports and communicates with internal and external customer as needed.
Provides support to the Quality and Performance Improvement Program, Performance Improvement Committees and Quality Design Teams including but not limited to the following activities: assistance with the scheduling and coordination of subcommittee meetings; preparation of meeting agendas; preparation of meeting minutes; committee correspondence and follow-up; development and implementation of annual work plans; provision of data and clinical management support for focused studies including measurement, analysis and reporting of data; assistance with maintenance of up to date documentation of committee/team activity in the preparation of annual evaluations, work plans and quality improvement activity forms.
Participates in the design, collection of data, analysis and reporting of clinical quality projects and quality initiatives as listed in the quality description; prepares high end reports for the FHW Service and Quality Oversight Committee and other outside agencies as necessary (such as Medicaid).
Participates in the survey process at FHW and maintains necessary documentation, binders and logs as required by regulation (such as the infection control log).
Maintains and oversees the staff in-service and training which includes coordination of new hire orientation, initial and annual competencies/skill lists for clinical employees (nurses, health aides, social service, activities) and schedules required annual in-services on all staff.
Performs medical record reviews on a quarterly and annual basis in all FHW settings to include providers including, but not limited to, day centers, nursing homes, home care, transportation and alternative sites. Monitors and maintains databases as listed in the quality work plan from QUM, annual and monthly satisfaction surveys, grievances, incident reports and infection control.
Oversees the completion of the MLTC state required reporting submissions and the tracking of these.
Coordinates FHW MLTC policy and procedure manuals to support the continuous performance improvement process and the quality of service provided by the department.
Oversees FHW Infection Control Program and log.
Oversees FHW Risk Management Program including the tracking and trending of incidents to identify opportunities for quality improvement.
In collaboration with the Program Director, ensures compliance with all regulatory and contractual requirements of NY State.
Creates business requirement documents for new or enhanced program reporting. Performs data validation on new and existing reports.
Contributes to development of new program initiatives and report elements for the program. Manipulates, prepares and distributes various reports utilized to evaluate the Program/staff performance including but not limited to elements associated with regulatory compliance, productivity, dashboard reporting and outcomes.
Performs system testing to ensure functionality, performance, reliability, stability and enhancements to the plan electronic medical record systems.
Evaluates data collections and methodologies, including format design, project criteria and requirements, data compilation, relevancy and usage based on and related to user or system design specifications
Identifies, analyzes, and interprets trends or patterns in complex data sets to prepare presentations for the MLTC leadership and plan staff.
Assists with resolving the findings of the audit or project, drafting the final report and helping develop a final system for the Program related to audit requirements
Serves as a systems/data and reporting resource within the Program by maintaining a high degree of visibility within the business and attending business meetings and appropriate management forums, providing a central point of information for all related program activities.
Develops ad-hoc reports as necessary.
Other duties as necessary
Degree in nursing required
RN; Certified Care Manager a plus
Minimum of 1 year related experience in a healthcare setting preferably with a geriatric population.
Minimum of 1 year experience with Managed Care insurance.
Quality Management/Performance Improvement experience preferred.
Experience with analyzing data required.
Strong knowledge of Microsoft Word, Power Point and Excel required.
Experience with Microsoft Access, relational databases a plus.
About Fallon Health:
Fallon Health is a mission-driven not-for-profit health care services organization based in Worcester, Massachusetts. For 45 years we have been improving health and inspiring hope in the communities we serve. Committed to caring for those who need us most, we pride ourselves on providing equitable access to coordinated, integrated care for our members with a special focus on those who qualify for Medicare and Medicaid. We also serve as a provider of care through our Program of All-Inclusive Care for the Elderly (PACE). Dedicated to delivering high quality health care, we are continually rated among the nation’s top health plans for member experience and service and clinical quality.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Fallon Health Vaccination Requirements:
To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Location US-NY-Amherst, NY
Posted Date 4 weeks ago (2/28/2023 11:04 AM)
Job ID 7208
# Positions 1