• Accurately performs data collection assignments including: utilization management, occurrence screens, death reviews, restraint reviews, quality reviews and other data collections tasks• Demonstrates knowledge and skills in Quality Management and Performance Improvement areas by accurately collecting and aggregating data, displaying data in the most appropriate graphical presentation, analyzing data, including developing action plans for improvement• Consistently identify and communicate to appropriate service level administrators and immediate supervisor patient care issues and takes appropriate action to address identified issues• Assists in the conduction of mock events in preparation for required surveys and audits• Demonstrates effective teaching skills by developing appropriate training/orientation materials • Participates in projects using lean principles and tools to improve the quality of care

• Works closely with the HIST department to ensure clinical systems are designed to provide appropriate and timely data• Participates in the development and implementation of data collection processes and tools• Ensures accurate collection of data for selected standardized measures of clinical quality• Reviews accuracy of data collected from electronic medical record (EMR) and other sources by performing audits to determine reliability and integrity of data• Work effectively with colleagues internally and externally to ensure that deadlines are met for data submission to various internal and external stakeholders• Ensures that data is available to support requirements of key external agencies such as CMS, The Joint Commission, and other professional groups to whom data is reported.• Assists in developing workflow to ensure required data is captured in usable format• Recommends and implements new standards and procedures for data input and collection• Acts as a “super-user” to ensure that the staff are trained and evaluated on their knowledge of and adherence to compliance with electronic medical record (EMR) recording/documentation

• Overall oversight, direction and implementation of the Continuous Quality Improvement requirements as required by DMAHS and the CMS• Oversees the collection, analysis, and reporting of HEDIS measures to CMS, DMAHS and other interested parties. • Works with staff across multiple departments to oversee implementation of interventions and programs to ensure consistent improvement of HEDIS and other publicly reported rates. • Works in concert with the NJ Medical Director to continually identify and evaluate opportunities to improve activities of the Quality Improvement Committee (QIC). Prepares summaries of activities and initiatives, as well as results, for the QIC, Board of Directors and other stakeholders as needed.• Coordinates with the designated Clinical Performance Management (CPM) team to conduct and submit quality improvement studies, medical record audits, and quality of care investigations and corrective action plans as required by state and federal agencies.• In coordination with Network Management, assists Healthfirst NJ providers to evaluate quality of care for their membership, present results of annual and interim quality measures, and develops new programs to improve these results.• Collaborates the scheduled audits conducted by CMS, DMAHS, DOBI or other regulatory/oversight agencies including organization of requested materials, developing written responses to questions, assisting other subject matter experts in preparing their own materials and responses.• Analyzes processes and procedures, updating them as necessary in accordance with state and federal regulations and the organization’s goals. Maintain appropriate policies and procedures for the department.