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Job Details

Clinical Quality Assurance Analyst

Requisition #: 266064
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Sept. 8, 2020

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.

POSITION SUMMARY:

Supports Health Services Utilization Management (UM) through Quality Assurance (QA) practices and oversight of UM functions. Works with departmental management and stakeholders to identity areas that would benefit from quality auditing oversight and monitoring. Assists in development of monitoring activities and reporting. Prepares and analyzes quality audit reports for trending to identify data integrity issues as well as performance and process gaps. Performs quality audits, feedback sessions, and other quality audit functions for Health Services staff. Specific areas of focus may be UM Intake (inpatient and outpatient), Clinical Appeals, Complaints and Grievance, and/or other areas of Health Services. Participates in testing and QA of system changes as necessary. Collaborates with and provides feedback to key stakeholders and Training staff.

TASK REQUIREMENTS FOR POSITION:

Supports Health Services Utilization Management (UM) through Quality Assurance (QA) practices and oversight of UM functions. Works with departmental management and stakeholders to identity areas that would benefit from oversight and monitoring. Assists in development of monitoring activities and reporting. Prepares and analyzes quality audit reports for trending to identify data integrity issues as well as performance and process gaps. Performs quality audits, feedback sessions, and other quality audit functions for Health Services staff. Specific areas of focus may be UM Intake (inpatient and outpatient), Clinical Appeals, Complaints and Grievance, and/or other areas of Health Services Participates in testing and QA of system changes as necessary. Collaborates with and provides feedback to Training staff.

REQUIREMENTS:

A. Education:

Clinical Quality Assurance Analyst

Bachelor’s degree required

B. Knowledge:

Must be well versed in NCQA, CMS, and State Mandated Quality Measures.

Must have knowledge of managed care products, health insurance benefits, ICD 9, CPT codes and medical terminology. Must be familiar with managed care operations, including utilization review, care management, behavioral health.

C. Skills:

Clinical Quality Assurance Analyst

Strong analytical and detail-oriented skills to organize/assess information; Problem solving skills to make recommendations based on data or authoritative resources; Ability to work independently; Ability to assess situations and respond appropriately by requesting training, documentation changes, and/or policy changes; Ability to effectively communicate, provide constructive feedback, and facilitate positive interdepartmental relationships; Ability to project a positive attitude and image by being professional, courteous, helpful and friendly in relationships with all levels of staff and management; Ability to work in multiple software applications and learn new applications quickly.

D. Required Licensure, Certification, Etc.:

RN licensure required

E. Work Experience:

Clinical Quality Assurance Analyst

5 + years in Acute HealthCare and Managed Care. Bachelor’s degree required. Must be well versed in NCQA, CMS, and State Mandated Quality Measures.

Knowledge and experience in utilization management, medical necessity review, clinical documentation with some quality auditing experience preferred.

Experience using Microsoft Office products required. Proficiency in reporting tools and databases such as Excel preferred.

Job Title: QA Analyst I, II

F. Machines, Tools, Equipment:

Normal Office equipment

DIMENSIONS:

A. Budget Responsibility:

None

B. Authority/Decision Making Level:

Organizes and prioritizes work to meet changing priorities. Develops reports and oversight activities. Makes decisions within the scope of authority and established guidelines.

C. Supervisory Responsibility:

None

PROBLEM SOLVING:

Clinical Quality Assurance Analyst

Performs critical thinking and analysis as it relates to data integrity for utilization management and other health services functions. Utilizes and reviews policies, guidelines, training manuals and procedures to ensure consistent application. May assist external auditors in analysis. Participates in testing system changes affecting Health Services workflows.

INFORMATION MANAGEMENT:

Clinical Quality Assurance Analyst -

Requires ability to prepare meaningful reports. Must be able to draw conclusions from data, track trends, and recommend solutions.

WORKING CONDITIONS:

Works in normal conditions where there are no physical discomforts due to dust, dirt, noise

and the like. Work frequently produces a high level of mental/visual fatigue due to attention to detail and adherence to deadlines.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

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