Facility Site Review/QI Coordinator / Job Req 822360580 (Manufacturing)

PRINCIPAL RESPONSIBILITIES:
Under the supervision of the Access to Care Manager, the Facility Site Review/Quality Improvement (FSR/QI) Coordinator is responsible for grievance and appeal reporting and for performing physical accessibility (FSR C, D, E) audits.

Principal responsibilities include:

Facility Site Review Duties
Conduct and participate in facility site review audits using the DCHS/Alliance Site Survey Tool and FSR Attachments C, D, E to assure compliance with local, federal, and state standards.
Arrange and schedule site surveys.
Assist on provider trainings regarding persons with disabilities assessment tool.
Identify opportunities for improving accessibility when recommended criteria are not met.
Prepare complete and accurate reports on facility site reviews in a timely manner, either manually or using appropriate software applications.
Assist with maintaining DHCS FSR database and internal FSR spreadsheets.
Identify trends, patterns, and opportunities for improvement seen over the course of a provider facility site review.
Monitor providers with corrective action plans, to ensure timely submission; follow-up, as indicated.
Communicate findings with Alliance and provider staff and make recommendations, as needed, for quality improvement activities and monitoring.
Follow policies and procedures regarding reporting of quality issues and assist in the preparation of reports and summaries for peer committees, as appropriate.
Educate providers and office staff regarding quality improvement processes and corrective action interventions, to come into compliance with Alliance, federal, state, and NCQA standards.
Assist with data analysis to identify significant and problematic issues and concerns, create improvement plans, and measure impact of actions.
Assist with maintaining internal FSR documentation and archive old files as needed.
Prepare complete and accurate state and federal quarterly reports.
Collaborate with Analytics department to build reports in response to new state and federal requirements.
Complete other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB
Travel for facility site review audits and QI activities.
Communicate and coordinate effectively, both verbally and in writing with PCPs, specialists, hospitals, and other providers.
Track and analyze data.
Perform writing, administration, data entry, analysis, and report preparation.
Make presentations.
Lead and participate in internal and external committees and meetings.
Comply with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.
PHYSICAL REQUIREMENTS
Constant and close visual work at desk or computer.
Constant sitting and working at desk.
Frequent use of keyboard and/or mouse.
Frequent use of telephone headset.
Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
Frequent lifting of folders and various objects weighing between 0 and 30 lbs.
Frequent walking and standing.
Routine and frequent driving of automobiles.
Number of Employees Supervised: 0
MINIMUM QUALIFICATIONS:
EDUCATION OR TRAINING EQUIVALENT TO:

Bachelors degree in Health Sciences or other related field.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

Two years health care experience, with a minimum one year experience in managed care.
Familiarity with Medicaid (Medi-Cal) and other publicly funded programs preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Proficient and demonstrated knowledge of medical terminology.
Strong verbal and written communication skills; ability to gather and analyze data; interpret and apply applicable rules and regulations; establish and evaluate priorities.
Strong interpersonal skills and the ability to anticipate and solve problems.
Strong attention to detail; able to concentrate with distraction in a fast paced environment.
Self directed with proven ability to work independently with minimum supervision; meet critical deadlines; follow up on assignments; handle multiple projects simultaneously.
Proven ability to work collaboratively with plan staff, providers, and provider staff.
Prompt and dependable; able to consistently meet deadlines.
Proficient with MS Word, Excel, Outlook, Access, and PowerPoint.
Able to understand and maintain confidentiality of sensitive information.
Possession of a valid California drivers license and auto liability insurance required.

Employees who interact with members of the public may be required to be tested for Tuberculosis and fully vaccinated against COVID-19 and influenza. Successful candidates for those positions/ classifications may be required to submit proof of vaccination against influenza and/or COVID-19, a negative Tuberculosis test, or request an exemption for qualifying medical or religious reasons during the onboarding process. Candidates should not present proof of vaccination until instructed to do so by the Human Resources department.