Lighthouse Guild is the leading not-for-profit vision and healthcare organization with a longstanding heritage of addressing the needs of people who are blind or visually impaired. By integrating vision and healthcare services and expanding access through education and awareness, we help people lead productive, dignified and fulfilling lives.
Reporting to the Director and Supervisor of QAPI, the successful candidate will oversee the collection, aggregation, analysis, and reporting of relevant clinical and utilization data related to GuildNet services. The data will be used to support program development, utilization of clinical resources, staff performance and clinical improvement activities. In addition, you will play an integral role in contributing to compliance with NYSDOH, Medicaid/Medicare regulations, as well as satisfying requirements of accrediting organizations, and supporting clinical improvement activities related to the development, implementation, and monitoring of clinical guidelines and protocols.
Performing routine record review at all GuildNet sites, including abstracting, interpreting, aggregating, analyzing and reporting data
Monitoring compliance with GuildNet policies, NYSDOH MLTCP contract, and regulatory requirements
Investigating complaints/grievances and coordinating plans of correction in conjunction with appropriate managerial staff and under the supervision of the Director of QAPI or designee
Auditing participating providers as assigned
Collecting, aggregating and disseminating data related to QAPI activities including IPRO studies, quarterly audits, satisfaction surveys, incident and grievance logs
Participating in special studies related to quality improvement activities such as the annual IPRO focused study
Performing staff performance audits, record audits, adherence to policy and providing written documentation of outcomes and recommendations
Participating in staff orientation and providing recommendations for probationary period extension and areas to be developed for continued employment
Identifying and working with staff who have been identified for remediation, involved in the retraining and remediation process, and documentation of progress or recommendations for continued employment
Handling other related functions as assigned
We offer competitive salary and a comprehensive salary benefits package. For consideration, please email your resume with the desired salary, to: firstname.lastname@example.org.
Equal Opportunity Employer M/F/D/V
Current NYS RN License
Associate or Bachelor’s (Master’s preferred) degree in a health-related field
At least 2 years experience in Quality Assurance/Performance Improvement auditing in home health, community services or a managed care environment, with demonstrated knowledge of quality improvement standards
Demonstrated knowledge of Medicare/Medicaid documentation standards and NYSDOH regulations, Managed Care regulations and NCQA standards
PC proficiency with MS Word, Excel, PowerPoint; Access and Crystal Report writing a plus
Superior analytical and oral/written communication skills
Internal Number: 0
About Lighthouse Guild
Lighthouse Guild is the leading not-for-profit vision + healthcare organization, with a long-standing heritage of addressing the needs of people who are blind or visually impaired, including those with multiple disabilities or chronic medical conditions. Through the integration of vision + healthcare services and the expansion of access through education and community outreach, our innovative and comprehensive approach helps people achieve and maintain the highest possible level of function and independence.