About Avalon Healthcare Solutions:
Avalon Healthcare Solutions is the world’s first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 44+ million lives and delivers 10-20% proven outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real-time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs.
Avalon is a portfolio company of Francisco Partners, a global private equity firm that specializes in investments in technology and technology-enabled service companies. Avalon is a high growth company where every associate has an opportunity to make a difference.
Avalon has years of expertise in managing lab benefits and now is leveraging digitized lab results to drive quality clinical outcomes and proven savings. When you look at how we bring this to life, we offer Lab Insights solutions that work together to arm you with critical lab-driven insights to accelerate your value-driven care success. This is the first-of-its-kind suite of solutions to help you achieve the Triple Aim of improving the patient experience of care, improving the health of populations, and reducing the per-member cost of healthcare.
You will be part of a team that shapes a new market and business. Most importantly, you will help Avalon to achieve its mission and improve clinical outcomes and health care affordability for the people we serve.
For more information about Avalon, please visit [www.avalonhcs.com](http://www.avalonhcs.com).
About the Clinical Quality Improvement Specialist:
The Clinical Quality Improvement Specialist facilitates the establishment of QI activities and methods of measurement that are prioritized to organizational priorities. This position collaborates with various functional areas to understand and alleviate obstacles as needed and monitors for successful performance via the Quality Improvement Committee.
This position is eligible for remote work, but quarterly travel will be required to Avalon’s corporate office located in Tampa, Florida.
Clinical Quality Improvement Specialist – Essential Functions and Responsibilities:
- Act as librarian/historian in association with departmental use of PowerDMS:
- Create/revise documents
- Maintain the Document Master Library in accordance with protocols for creation, revision, naming, versioning, etc.
- Migrate documents out of Box and into Power DMS
- Publish all approved documents for the department in Power DMS on an ongoing basis
- Establish annual QI Work Plan document which defines quality improvement priorities from both an activity and metric standpoint; update to insert data and information as received; conduct annual evaluation.
- Pursue methods to ensure receipt, trending and appropriate analysis of data associated with various QI Work Plan metrics.
- Monitor required QI Work Plan metric trends, identify variation, convene functional area or cross-functional teams as needed to conduct root cause analysis and institute meaningful action to achieve defined performance goals.
- Develop and monitor quality reports.
- Review QI and Utilization Management Program Description documents; identify and act on any need for revision identified.
- Assist with creation and maintain all materials associated with:
- QI Program/Work Plan activity, including committee meeting materials.
- Client health plan delegation oversight
- Set agenda/create Quality Improvement Committee meeting materials to drive desired meeting outcomes and ensure proper recording of committee activities.
- Perform various department functions and processes, such as those associated with client health plan delegation oversight, internal auditing functions, and annual QI/UM operational policy review and revision.
- Interact with client health plan and Avalon vendor staff (such as Advanced Medical Reviews) as needed to ensure compliance with expectations associated with delegation.
- Establish and implement a process to regularly assess for changes in NCQA accreditation standards, detail changes in content and/or processes that would be required, and work to achieve organizational compliance.
- Assist with creation, implementation, and regular oversight of project plans developed to
- Achieve new client health plan integration, which would include steps necessary to assimilate medical policy
- Address client health plan delegation oversight, either prior to go-live, or upon annual re-assessment.
- Advance Avalon NCQA UM certification pursuit.
- Act as project manager for NCQA accreditation pursuit, as may be required by client health plans.
- Manage and monitor clinical quality studies that may be undertaken by Avalon, to include receipt and analysis of trended data, assessment of national benchmarks as available, development of improvement recommendations (to include ROI and best practice interventions as appropriate), presentation to senior leadership, implementation of plan, and evaluation for desired result.
- Other duties as assigned by Manager.
Clinical Quality Improvement Specialist – Minimum Qualifications:
- 3-5 years of Health Care Quality Improvement experience in a managed care or health care services vendor relationship setting.
- Bachelor of Science in Nursing (BSN) Preferred
- Current active, unrestricted Register Nurse (RN) license
- Working knowledge of NCQA health plan accreditation requirements.
- Working knowledge of Medical Policies and clinical coding.
- Strong knowledge of Health Plan claims, medical billing, and coding
- Expert proficiency in written and oral communication skills required.
- Expert proficiency in computer skills including Microsoft Office Suite products.
- Strong understanding of health insurance claims and terminology.
- Strong communication, delivery, and presentation skills.
- Exceptional interpersonal skills with demonstrated ability to work independently as well as with a team.
- Strong organizational skills.
Clinical Quality Improvement Specialist – Qualifications Preferred:
- Certified Medical Billing and Coding preferred.
- Lab/Genetic test experience/familiarity.
- Certification in Healthcare Quality, Project Management or Six Sigma