Clinical Quality Specialist - Northeast Georgia ...

Job Category: Physician Services / Physician Clinics Work Shift/Schedule: 8 Hr Morning - Afternoon Northeast Georgia Health System is rooted in a foundation of improving the health of our communities. About the Role: Job Summary The Clinical Quality Specialist is a key member of the Department of Clinical Quality & Ambulatory Pharmacy Services, and endeavors to ensure that the group is providing the highest levels of quality care and service to our patients. This role is responsible for assessment and measurement of clinical performance, assists in the oversight of non-licensed staff in the department, and for successful compliance with standards/rules/regulations of pay for performance partners. This position interacts with provider, administrative leaders, managers and staff as a resource to achieve desired pay for performance, population health, and performance improvement outcomes. This position also provides support and guidance to improvement and problem-solving initiatives and reporting results to appropriate leaders and organizational committees. Minimum Job Qualifications Licensure or other certifications: Current license as a RN in the State of Georgia required. Current BLS certification required or must be obtained within 30 days of hire. Educational Requirements: Associates Degree. Graduate of accredited school of nursing supporting RN licensure. Minimum Experience: RN: Two (2) years of broad clinical experience required; Other: Preferred Job Qualifications Preferred Licensure or other certifications: CPHQ/CPHRM certification or other quality certification (or willingness to pursue within 12 months of employment). Preferred Educational Requirements: Bachelors degree highly. Preferred Experience: Previous responsibility or experience in quality or performance improvement. Other: Job Specific and Unique Knowledge, Skills and Abilities Strong interpersonal skills, excellent communication skills, and dedication to providing superior customer service with the ability to express genuine care and concern when dealing with patients/families and other internal customers Ability to analyze data and patient care processes in a systematic fashion Keen attention to detail, strong critical thinking and problem-solving skills Knowledge of personal computers, electronic medical records, and data gathering and review Ability to work at a rapid pace with numerous interruptions Demonstrates a high degree of self-motivation; ability to work both independently and as a member of a dynamic team Ability to work with and maintain highly confidential information Essential Tasks and Responsibilities Performs chart abstractions, chart audits, and documentation reviews to comply with organizational policies and pay for performance initiatives. Provides education to providers and staff when deficiencies are identified in order to achieve higher compliance scores on quality measures for NGPG goals, payor objectives, and accreditation requirements. Responsible for reviewing payor HEDIS and pay-for-performance reports; performs chart reviews and audits to identify issues, and collaborates with payors to correct identified issues; builds strong relationships with managed care (payor) representatives. Investigates variances and potential risk issues related to key pay for performance metrics, performing mini root-cause analysis and/or deep dive investigations where appropriate. Assists in the orientation, development, and oversight of non-licensed staff (Medical Assistants, Pharmacy Techs) with regard to pay for performance and population health initiatives. Partners and collaborates with care management staff when necessary and as requested. Provides training and education to Practice Managers and new providers when requested as part of the on-boarding and orientation process; may provide ongoing training and at the elbow support in meeting metrics as required. Collaborates in the assessment of population health management technology, to include ongoing optimization, maintaining strong relationship with vendors, training staff and providers on use of technology, and ongoing reporting functions where applicable. Participates in metric compliance investigations, to include chart reviews, reporting, and interviews with involved staff members and third party payors. Support, provides and oversees annual abstraction requirements for CMS Medicare pay for performance programs. Participates as a member of various quality/performance improvement related committees and improvement teams that further pay for performance and population health initiatives. Collaborates effectively with HP2 and Longstreet staff in order to build robust relationships for the purposes of sharing best practices, creating efficiencies, and optimum patient care outcomes for patients in the clinically integrated network. Coordinates and acts as a liaison between various NGPG and NGMC departments, physicians, and with meetings, updates, reports, or other planning required in support of clinical integration between the outpatient and inpatient setting. May serve as Quality liaison for NGPG practices and providers, assisting in the development of performance improvement plans and projects. Maintains a commitment to professional growth by staying current with requirements of payors and accreditation bodies (NCQA, DNV, etc) as well as quality and LEAN methodologies; is committed to ongoing education and professional development in assigned areas of responsibility. Advocates for continuous performance improvement and superior customer service throughout the organization. Other duties as assigned. Physical Demands Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time Weight Carried: Up to 20 lbs, Occasionally 0-30% of time Vision: Heavy, Constantly 66-100% of time Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking: Frequently 31-65% Pushing/Pulling: Occasionally 0-30% Intensity of Work: Frequently 31-65% Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here. Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

Created: 2026-03-10