Overview
QA Engineer – Automation Jobs in Newark, NJ at JSR Tech Consulting
Quality Provider Oversight Lead – (2500009N)
Description
The Quality Provider Oversight Lead is responsible for the integrity, assurance, and improvement of the quality delivered to HSCSN enrollees This role will work closely with HSCSN Quality Assurance leadership, HSCSN various departments, Children’s National partners, and external vendors and stakeholders as an enrollee advocate and quality provider liaison to develop and improve processes, address ongoing/potential areas of quality deficiencies or risks, and ensure high value of care delivery for enrollees services.
Qualifications
Minimum Education
Bachelor’s Degree in nursing (BSN) (Required)
Minimum Work Experience
5 years of experience in the area of quality and health outcomes, community health nursing and/or home health care. (Required)
Required Licenses and Certifications
Registered Nurse .
Job Functions
Essential job duties:
Developing and maintaining provider engagement, oversight and education using quality oversight processes
Outline the current processes for identification of enrollee needs across the HSCSN provider network through the lens of quality monitoring, oversight, provider education, connection to care, delivery of services, and transition out of care in partnership with the multiple teams (both internal and external to HSCSN) and stakeholders involved in these processes.
Coordinate the collaboration, process alignment, policy/procedure documentation, training and evaluation of the HSCSN departments involved with delivering or assuring quality outcomes, services, experience for HSCSN enrollees (including but not limited to Quality, Medical Affairs, Provider Relations, Compliance/Risk, Appeals/Grievances).
Establish SMARTIE goals and quality measures to study effectiveness of processes and procedures to ensure highest quality of care delivery.
Be the subject matter expert (SME) on quality standards, offering training and supports to HSCSN teams as they work with enrollees
Ensure high quality providers by ensuring comprehensive training and education. Responsibilities include but not limited to:o Conduct ongoing trainings with providers needing engagement and education to support HSCSN Quality goal in alignment with DHCF Quality Strategyo Collaborates with Compliance, Medical Affairs and Appeals and Grievances review quality related complaints, support the development and monitoring of corrective action plans. o Submit reports to DHCF, including quality related corrective action plans, for all home health agencies on site visits, point of care home visits, on/off site financial/claims audits as outlined in our CASSIP contract or requested ad hoc by regulator.o Collaborate with Home health agency & staff to attend and participate in mandatory trainings for Contract compliance at least twice a year.  Ensure Home health agencies with corrective action plans (including financial sanctions) include continuous close monitoring (quarterly at a minimum) and receive individual and small group refresher training sessions and resource support for billing, clinical and administrative problems.  Submit documentation of all training and education meetings to internal stakeholder for review/approval. Notify DHCF in advance of scheduled training and education sessions for home health agencies.o Convene monthly forums with the Quality, Compliance and Provider Operations Departments and CMO (as needed) to capture the status of work activities with home health agencies. As requested, ensure summary report from focus forums are submitted to DHCF.
Implement and study improvement strategies to improve HSCSN provider network engagement, education needs, as well as home care experience for HSCSN enrolleeso Applies the Institute for Healthcare Improvement’s Model for Improvement and PDSA cycles to study processes and evaluations/feedback to lead to continual approval of the home care process for HSCSN enrollees. o Using internal key performance indicators, enrollee experience data (through surveys, appeals/grievances/complaints, etc), survey responses, audit results, and stakeholder feedback will work in multidisciplinary teams to understand root cause of barriers, plan process improvements, implement change, and study effectiveness of change to decide on adjustments needed to better care.
Ensure HSCSN provider focused quality engagement activities and home health oversight process and outcomes are included in the Quality Assessment and Performance Improvement (QAPI) Program, workplan, and evaluation.
Ensure HSCSN enrollees are receiving high quality services through quality outcome measures (CAHPS, HEDIS, EPSDT), ongoing education & monitoring, audits, and investigation of G&A
Audits: Schedule and coordinate internal monitoring/audits of HSCSN processes • In collaboration with HSCSN Credentialing Department, conduct site visits for initially credentialed practitioners, document / submit findings to Credentialing Department and as applicable report out findings in appropriate sub-committee. • Conduct site visits and financial/claims audits of every home health agency in the Provider Network at minimum annually, but more frequently when required by regulator, leadership, or required by corrective action plan.o Conduct unannounced site visits on a routine basis to evaluate quality of clinical care and ensure compliance with contractural standards. o Ensure that only home health agencies with a pediatric certificate of need (CON), administered by DOH, shall provide home health services to children and adolescents.o Submit to DHCF annually, for review and approval, all on site monitoring and evaluation tools utilized for home health agencies by the Quality, Compliance and Provider Operations Departments. Submit any proposed revisions to monitoring and evaluation tools to DHCF for prior approval before use.o Participate as home care lead in external audits (I.e. OSR) or accrediting efforts (I.e NCQA) to make sure HSCSN’s policies and procedures are meetings standards and striving for excellence.
Home Health Appeals/Grievances/complaints: • Implement and maintain a system for accepting, logging, tracking, resolving and monitoring all home health agency complaints received from parents/caregivers and adult Enrollees, DHCF, DOH or other community stakeholders. • Ensure process is reviewed monthly by mutidisciplinary committee, including members form the Appeals and Grievances, Quality, Compliance, Medical Affairs, and Provider Operations Departments. • Collaborates with Compliance and Appeals and Grievances and/or other HSCSN teams to prepare complaints reports including corrective action plans for submission to DHCF quarterly and upon request. • Submit reports to DHCF, including quality related corrective action plans, for all home health agencies on site visits, point of care home visits, on/off site financial/claims audits as outlined in our CASSIP contract or requested ad hoc by regulator.• Facilitate meetings between enrollees/enrollee caregivers and home care agencies to help reach a mutual understanding of care goals and resolve disputes/complaints.
Other job duties:
May perform other duties in addition to those outlined in this job description.
Knowledge of:
• Centers for Medicare & Medicaid Conditions of Participation for home health agencies, the DC regulations for home care agencies, and scope of practice for various provider types (RNs, LPNs, PCAs, etc). • Quality improvement and general quality concepts (I.e. if no formal training, would be asked to complete IHI Basic Certificate within 90 days of start) • Available home care services and provider types • Nursing assessment, diagnosis, planning, intervention, and evaluation process • The healthcare environment as it relates to the care delivery systems • NCQA regulations and expectations including compliance requirements• Age-specific care • Culturally sensitive care
Organizational Accountabilities
Organizational Accountabilities (Staff)
Employee Excellence
Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence standard is achieved
Innovates through improvement of care and/or efficiency of operational processes.
Dedicated to a standard of performance excellence and high quality
All In
Embraces changes/improvements and actively participates in the implementation of new/improved programs, technology, new equipment, systems and resources that promote quality of care, safety and efficiency
Identifies, prioritizes and selects alternative solutions to determine best outcome
Action Oriented
Maintains a high level of activity/productivity, meeting deadlines and appropriately prioritizing tasks to meet business demands
Anticipates problems and attempts to solve before they develop
Supervisory Responsibilities
None
Blood Borne Pathogen Exposure
Category III: Job does not involve exposure to blood, body fluids, non-intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.
Protected Health Information Access Level
Level IV – Full Access Incumbents in this job may access any protected health information associated to a customer’s needs, the service(s) rendered and the position’s functions.
Working Environment
This job operates in a hospital or office environment.
Physical Requirements
Sedentary Work: Lifting 10 lbs. maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one that involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.
Travel Requirements
May require some travel.
Primary Location: District of Columbia-Washington
Work Locations: HSCSN – Vermont Ave 1101 Vermont Ave NW Washington 20005
Job: Nursing
Organization: HSC W/Special Needs
Position Status: R (Regular) – FT – Full-Time
Shift: Day
Work Schedule: Mon-Friday 8:30-5
Job Posting: Feb 6, 2025, 3:51:34 PM
Full-Time Salary Range: 82347.2 – 137238.4
Title: QA Engineer – Automation
Company: JSR Tech Consulting
Location: Newark, NJ
