Quality Consultant Job Description
Quality consultant
provides practice level quality transformation through targeted clinical education and approved materials related to HEDIS/State Specific quality measures for provider and staff education during field visits.
Quality Consultant Duties & Responsibilities
To write an effective quality consultant job description, begin by listing detailed duties, responsibilities and expectations. We have included quality consultant job description templates that you can modify and use.
Sample responsibilities for this position include:
Provide general insights to the business on a regular basis, identifying key training requirement, or opportunities for process improvements where relevant
Maintain and improve current knowledge of industry standards and practices by completing mandatory training and case studies as required
Facilitation of Interdisciplinary Care Team meetings and the assurance of timely follow-ups to address members plans of care
Execution and evaluation of program policies, procedures, alignment with the MOC, and compliance with all state and federal requirements
Coordination with the care management team to ensure members are receiving needed services
Review exception reports and clinical documentation system to identify missing requirements or MOC processes
Operate as the point of contact for the care management team to ensure the care managers are notified of any alerts, concerns, inpatient notifications, for their assigned members
Participate in regular Care Transition Team meetings
Assist with preparation for state audits, NCQA, and any additional accreditation audit activities
Execution and evaluation of program policies, procedures, and alignment with the MOC
Quality Consultant Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Quality Consultant
List any licenses or certifications required by the position: ISTQB, CIC, IP, ASQ, SQL, MCSA, PMP, 9001, ISO, QMS
Education for Quality Consultant
Typically a job would require a certain level of education.
Employers hiring for the quality consultant job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Master's Degree in Education, Healthcare, Nursing, Health, Business/Administration, Healthcare Management, Economics, Health Care Administration, Computer Science, Business
Skills for Quality Consultant
Desired skills for quality consultant include:
Medicare market
Products and competitors
Managed care requirements related to clinical quality
Billing/claims submission and other related actions
EMR for recording patient visits
ICD10
Air quality outlook
HEDIS
Coaching others
Training
Desired experience for quality consultant includes:
8+ years in the Pharmaceutical/Biotechnology industry, with at least 3 to 4 years of GCP-Auditing experience
Pre-Approval Inspection readiness audit experience
Experience handling trial essential documents both at the sponsor and site level
Expertise in GCPs, ICH Standards, and FDA Code of Federal Regulations for clinical trials
Bachelor’s Degree in Mathematics, Statistics, Informatics, Economics, Finance, Business, Healthcare or a related field
Proven ability to align and motivate internal and external key process stakeholders
Quality Consultant Examples
1
Quality Consultant Job Description
Job Description Example
Our innovative and growing company is looking for a quality consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for quality consultant
- Assist the QM Director with training and mentoring by identifying and developing the skills of the QM and Underwriting staff
- Assist with preparation for NCQA and any additional accreditation audit activities
- Prepare Quality scorecards by integrating, analyzing and correlating data from various sources (Customer Satisfaction, KPIs, Interaction Analytics, Average Handle Time, Consultative Selling, ) to enable managers to spend their time ‘actioning’ rather than collecting & analyzing data
- Drive improvements to maximize value of data quality
- Coordinates the medical staff quality program (peer review, ongoing and focused professional practice evaluation, proctorship)
- Coordinates and facilitates action planning for identified medical staff quality issues
- Coordinates medical staff conduct process
- Manages medical staff quality data for clinical scorecards, reappointment reports, mortality review
- Act as a sparring partner at executive and managerial levels, translating business needs and opportunities into specific solutions that bring value to the customer
- Play a vital role in expanding the Industry Consulting group´s expertise by keeping up with the latest developments in product- and process quality and reliability and by building a network of contacts and resources
Qualifications for quality consultant
- BA/BS within a scientific discipline
- Demonstrated accuracy and thoroughness to identify process improvements and foster quality in others
- Work within deadlines being resourceful, demonstrating independence, and using self-management skills
- Recent experience in the managed health care industry
- Minimum of 2 years relevant Medicare and/or Medicaid experience
- Residence in the geographic area of Oak Brook, IL preferred
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Quality Consultant Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of quality consultant. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for quality consultant
- Rehabilitation knowledge to understand the best case management approach for customers
- Understanding of how their decisions affect customers and business outcomes
- Cross enterprise collaboration skills, a positive attitude and good interpersonal skills
- A strong focus on ensuring quality is maintained and delivered across the business
- Open and honest manner and strong communication skills both written and verbal
- Ability to build rapport with team members to deliver effective coaching through a partnership approach
- Deliver feedback to the Case Manager during coaching sessions, where a Progression Plan for ongoing coaching and development will be established
- Review and quality check Statements of Advice (SOA), marketing and other advice documents to ensure compliance, legislative and licensee standards are being met
- Contribute to the continuous improvement of vetting processes by participating in team meetings, providing feedback on and discussing breaches of standards with the team during regular meetings
- Contribute to risk minimisation by identifying potential risks within the vetting processes and discuss possible solutions with the National Manager, Advisory Services & Quality Advice or delegated individuals
Qualifications for quality consultant
- Bachelor's Degree or 3 years of experience with quality in a managed care environment
- Ability to read, analyze data reports, complex compliance procedures, and govermental regulations
- Work within deadlines being resourceful, demonstrating independence, and using self-management
- RN or clinical license a plus
- Residence in the geographic area of Saint Petersburg, FL
- Expertise with Microsoft Excel with experience understanding/creating graphs and pivot tables
3
Quality Consultant Job Description
Job Description Example
Our company is looking for a quality consultant. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for quality consultant
- Define strategies and implementation program(s) for deploying Vault Quality across an organization globally
- Content management solution design, prototyping, configuration and documentation
- Project management including resource planning, leading and motivating a cross-functional team, and project tracking and forecasting
- Mentor project team and junior consultants in the Professional Services organization
- Represent Professional Services across multiple engagements and workstreams (e.g., solution design and configuration, data migration, systems integration)
- Ensure customer success from beginning to end of the engagement life cycle
- The QS IT Consultant will be responsible for Quality Services for all projects within project vertical markets
- Satisy the needs of the business
- Provides leadership for staff development related to specified programs
- Organizes and leads regulatory readiness for specific programs
Qualifications for quality consultant
- Working knowledge of Microsoft Access, SQL, Visio and Apex
- Work independently member of a team
- In depth knowledge of UK legislation and policy influencing air quality assessment and latest guidance/modelling methods
- Experience in the application of DMRB and associated Interim Advice Notes
- In depth knowledge of local legislation and policy influencing air quality assessment and latest national guidance/modelling methods
- A working knowledge of International Finance Institution (IFI’s) guidelines and their implementation
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Quality Consultant Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of quality consultant. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for quality consultant
- Possess a deep understanding of the Medicare STARS program and become subject matter expert and conduct training assist with implementation and execution of strategy related to the quality incentive program
- Contribute to the development and management of provider and office staff training programs for capture of STARS and Pay-for-performance codes
- Contribute to the development and execution of multiple provider campaigns focused on improving clinically oriented HEDIS and HOS scores customer satisfaction oriented CAHPS survey results
- Provide organizational support for performance improvement and strategic initiatives, including team facilitation, data management/analysis, rapid cycle improvement and change management
- Serve as the stroke program coordinator, core measures quality lead and readmission reduction lead for the organization
- Highly skilled technical Underwriter and QM Consultant
- Lead and perform Knowledge Matrix technology build of any new or revised QM Programs including but not limited to question / answer development and scoring parameters
- Assess current QM Program Portfolio to ensure that it reflects the most current practices
- Challenge QM Program Portfolio and promote idea generation through observation and customer feedback
- Ensure consistency of the execution of the QM Review Process by managing ongoing validation of the QM Consultants
Qualifications for quality consultant
- Must reside within driving distance of the Oak Brook Office in Chicago, IL
- Experience in provider relations and education
- Dedicated home office space
- Responsible for identifying testing requirements by analyzing user stories, create test plan, develop test cases/scenarios, setup supporting test data and execute test cases manually and using automated tools as well
- 1+ years of experience working with UNIX, QTP, any ETL data mapping/transformation tools
- Experience in creating and implementing test methodologies, processes, and associated tools
5
Quality Consultant Job Description
Job Description Example
Our company is searching for experienced candidates for the position of quality consultant. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for quality consultant
- Review all Cases that fail to meet minimum scoring requirements prior to QM Consultant delivery
- Handle first line of appeals from Underwriters and Underwriting Management
- QM Reporting Lead responsible for reporting overall Underwriting results, trends, analysis and recommendations to the business
- Coach and mentor QM Consultants on how to report business unit results, trends, analysis and recommendations to their assigned business units
- Based on business needs, provides support to the business during Peak periods by actively participating in Strategic Reserve, taking Case assignments and collaborating effectively with the business (Underwriting & Sales) to meet customer deadlines
- Review underwriting files for Regional and National account segments
- Lead QM Projects, Review Programs and Audits
- Maintain the QM Site pages and ensure that they reflect the QM’s current practices
- Support and drive Employee Engagement
- Working with Danfoss Procurement in Supplier selection and de-selection process ensuring correct suppliers are selected
Qualifications for quality consultant
- Constant communication with operational teams, suppliers, and other process partners to ensure consistent processes throughout the network, grief resolution
- Strong presentation skills with the ability to present to all levels of leadership
- Prior experience as a Claims Case manager or as a recovery specialist in the Insurance industry
- Experience in both dispute management and quality checking
- High level proficiency in Microsoft Suite of Products with the ability to work in/create advanced excel spreadsheets and work effectively and efficiently in Excel, SharePoint, Access and other programs
- Experience in a mentoring or coaching role