Clinical Quality Study Analyst

About the role

Conducts focused reviews, quality studies, and quality improvement projects according to appropriate contract standards. Investigates medical records retrospectively for potential quality and utilization issues. Ensures compliance with the program requirements for Clinical Quality Management (CQM) for Veterans and/or DoD beneficiaries. Maintains URAC standards in work products.

Responsibilities

• Conducts research and writes clinical quality studies to identify, develop and evaluate processes to improve delivery of care to Veterans and/or DoD beneficiaries.
• Acts as facilitator on quality improvement team projects and utilizes appropriate quality improvement methodologies and standardized quality management tools.
• Leads and performs quality management audits.
• Identifies, develops, and monitors focused reviews and other quality studies.
• Identifies Potential Quality Issues (PQIs) by performing a timely review of the medical records. This includes researching, investigating, analyzing, and preparing case summaries with recommendations for further review.
• Reviews Potential Quality Issues with Medical Directors when appropriate.
• Prepares peer reviewed cases for quality committees and monitors corrective action plans.
• Uses data management software to identify physician practice patterns, over- and under-utilization of care and services, complication rates, and high-cost outliers.
• Prepares and submits activity and projects reports.
• Performs other duties as assigned.

Requirements

• Registered Nurse with current unrestricted license in appropriate state
• 1 year experience in Quality Management
• 1 year experience in data analysis and writing clinical quality studies
• 5 years Medical/Surgical experience
• US citizenship and a favorably adjudicated DOD background investigation if selected to work under TRICARE/DoD Contract

Qualifications

• Bachelor’s degree in Nursing or CPHQ preferred
• Experience with team facilitation and project management
• Experience with Medicare, Veteran’s Administration, TRICARE, or other government health care programs

Skills

• Commitment to Task
• Communication / People Skills
• Computer Literacy
• Independent Thinking / Self-Initiative
• Organizational Skills
• Problem Solving / Analysis
• Technical Skills

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• Medical, Dental and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

Pay

$91,000 - $100,000 per year

Schedule

Regular and reliable attendance is required.

Company Overview

Taking Care of Our Nation’s Heroes. It’s Who We Are. It’s What We Do. Do you have a passion for serving those who served? Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®! Our job is to make sure that America’s heroes get connected to health care in the community. At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.