Quality Enhancement Specialist

CINQ Connect NY LLC

Overview

The Quality Enhancement Specialist reports to the Director of Compliance & Quality, CINQ Care Inc., with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet CINQ Care Inc.’s requirements. The Quality Enhancement Specialist should embody CINQ’s core values, including: Trusted, Empathetic, Committed, Humble, Creative, Community-Minded.

The Quality Enhancement Specialist will have the following responsibilities:

• Reviewing and auditing member charts for quality assurance, accuracy of documentation, and completeness ;

• Reviewing member enrollments for quality assurance, accuracy of documentation, and completeness;

• Reviewing and routing Admission, Discharge, and Transfer (ADT) alerts from Managed Care Organizations within MEDENT;

• Monitoring Patient Health Navigator follow-up upon receipt of transitions of care notifications to ensure safe and timely transitions of care are conducted;

• Reviewing DM/HM reports in MEDENT;
• Monitoring adherence to triage and to-do deadlines in MEDENT;
• Managing member consents in HEALTHeLINK RHIO and in PSYCKES
• Reviewing member complaints entered into Performance Portal or received by other means and following up with members and other involved parties while providing customer service and promoting member retention;

• Coordinating with Care Management Agencies (CMAs) as a point-of-contact to perform CMA chart transfers and respond to general inquiries;

• Reviewing and auditing all CMA member charts for quality assurance, accuracy of documentation, and completeness

• Reviewing incidents placed in Performance Portal by all CMA’s and reporting to NYSDOH for those considered reportable

• Attends meeting with CMA Point of contact staff on a monthly basis and report audit findings, areas of improvement etc;

• Attend meetings with MCO’s on a monthly basis as required;
• Reviewing and processing health home transfer requests;
• Reviewing and processing member disenrollment’s;
• Maintaining and updating MEDENT components, including staff lists, PCP and Pharmacy databases, and the rolodex;

• Merging duplicate member accounts in MEDENT;
• Recording and analyzing complaints and disenrollment data for analysis of patterns and trends;
• Resolving account password reset requests (ePACES, HEALTHeLINK, MEDENT, RELIAS etc.);
• Reporting summarized results of data analysis to the Director of Compliance and Quality and the Quality Committee;

• Assist with National Committee for Quality Assurance (NCQA) recognition and/or accreditation program requirements;

• Other tasks within the scope of the Compliance Department as assigned by the Director of Compliance and Quality;

• The Quality Enhancement Specialist must also have a thorough understanding of internal and external care coordination, health home billing, and quality management policies and procedures;

The Quality Enhancement Specialist shall have following duties:

• Leadership: The Quality Enhancement Specialist will lead in defining and executing strategies and solutions to create business value including building a team to design, develop, and execute those strategies and solutions to deliver desired outcomes.

• Strategy: The President will establish the business strategy and roadmap: (1) improve outcomes for CINQ Care Inc. members; (2) enhance the efficacy of other CINQ Care Inc. business divisions; and (3) develop and deliver external market opportunities for CINQ Care products and services. In establishing the business strategy, the Director of Quality will define and innovate sustainable revenue models to drive profitability of the Company.

• Collaboration: The Quality Enhancement Specialist will ensure capabilities form a cohesive offering, including by working closely with other business divisions to learn their needs, internalize their knowledge, and define solutions to achieve the business objectives of CINQ Care Inc.

• Knowledge: The Quality Enhancement Specialist will provide subject matter expertise in the [area] solutions, including determining and recommended approaches for [specify], solution deployment and performance evaluation.

• Culture: The Quality Enhancement Specialist is accountable for creating a productive, collaborative, safe and inclusive work environment for the team and as part of the larger Company.

The Quality Enhancement Specialist should have the following qualification:

• Education. Bachelor’s or equivalent degree with a record of strong academic achievement; MBA preferred but not required;

• Experience. At least 2 years of MEDENT EMR experience. Ideal candidates will have 2+ years of relevant Health Home experience in the healthcare industry;

• Entrepreneurial. CINQ seeks to fix gaps that have persisted for generations in the delivery of care to Black and Brown populations. This position is accountable for ensuring CINQ is positioned to innovatively deliver on its promise;

• Communication. Excellent verbal, written communication and presentation skills; ability to clearly articulate and present concepts and models in an accessible manner to CINQ’s team, investors, partners and other stakeholders. Proficiency in all Microsoft Office applications;

• Relationships. Ability to build and effectively manage relationships with business leaders and external constituents; and,

• Culture. Good judgement, impeccable ethics, and a strong team player; desire to succeed and grow in a fast-paced, demanding and entrepreneurial Company.