ECM Quality Assurance & Training Lead

Central-Neighborhood-Christian-Health-Clinics; San Bernardino (CA); On-site; USD 75,000 - 95,000; Full time

Job summary

Central Neighborhood Health Foundation is seeking an ECM Quality Assurance Coordinator to collaborate with the Quality & Contracts Supervisor and ECM Director to deliver a comprehensive training program and QA program for the ECM program and staff.

The role includes monitoring quality metrics, managing patient data, preparing monthly reports, and coordinating with LCM staff and clinical consultants to ensure care coordination and adherence to ECM standards.

Qualifications

• Bachelor’s Degree or MPH, MBA, MHA, or related Master’s degree preferred or relevant experience.
• Experience in delivering training preferred
• Experience with Managed Care/Hospital work experience required
• Prior experience performing quality assurance in a healthcare environment

Responsibilities

• Monitor and improve monthly the Quality metrics for all program staff, including but not limited to billing errors, number of encounters, care plan, comprehensive assessment, and authorization compliance.
• Track, manage, document, identify, and report patient data.
• Assist with monthly reporting, such as creating RTF/OTF, SCR, and CLR.
• Ensure member assignment to by health plan to CNHF.
• Distribute and monitor the caseload for all LCM staff.
• Audit exclusions to ensure all required documentation is on file.
• Data entry as needed.
• Work closely with LCM and clinical consultants to ensure coordination and transition of care.
• Monitor health plan portals for reports and hospital notifications and distribute hospital notifications to staff.
• Prepare reports/deliverables for submission to meet Quality requirements, including monthly action plans to LCMs as part of continuous process improvement.
• Participating in monthly health plan meetings and training.
• Participate in Quality Management team planning meetings as requested.
• Utilize a variety of reports to perform QA on all functions within ECM, providing supervisors with the data needed to have constructive feedback sessions with their staff.
• Utilize quality assurance activities to identify opportunities for additional training and/or enhancements to the curriculum and develop training materials
• Coordinates assigned quality and process improvement activities, which may include process improvement projects, quality studies, CQI process training for staff, prevention program coordination, and care coordination initiatives.
• Conducts quality control reviews and internal audits. Summarizes findings and prepares reports on findings.
• Conducts analyses of data findings for quality and process improvement and assists in report preparation for the Quality & Contracts Supervisor and ECM Director.
• Supports assigned quality activities through comprehensive project management, ensuring that documentation is accurate and timely.
• Review patient healthcare information and records.
• Define the level of care for the tier system.
• Advise staff and other clinical and non-clinical staff on ECM standards and procedures.
• Interacts with nurses, department managers, supervisors, and ECM staff members to provide resource information, resolve ECM-related problems, and identify new opportunities to improve service.
• Perform other duties as assigned.

Skills

Interpersonal skills

Communication skills

Organizational skills

Presentation skills

Teamwork

Confidentiality

Empathy

Problem-solving

Deadline management

Training delivery

Education

Bachelor’s / MPH / MBA / MHA or related Master’s preferred

Job description

Central Neighborhood Health Foundation is seeking an ECM Quality Assurance Coordinator to collaborate with the Quality & Contracts Supervisor and ECM Director to deliver a comprehensive training program and QA program for the ECM program and staff.

The role includes monitoring quality metrics, managing patient data, preparing monthly reports, and coordinating with LCM staff and clinical consultants to ensure care coordination and adherence to ECM standards.