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Quality Improvement Specialist, Care Transitions in Phoenix, AZ at HSAG

Date Posted: 10/26/2018

Job Snapshot

Job Description


Reducing unnecessary readmissions is a key component to reducing costs, increasing efficiency and reforming the healthcare system. As part of a nationwide effort to reduce avoidable 30-day l readmissions, you will work closely with hospitals, nursing homes, home health agencies, pharmacies and community based organizations to improve the transitions and coordination of care for Medicare beneficiaries. This position is responsible for coordinating and implementing a broad range of collaborative, community activities among healthcare providers to improve health and health care for all Medicare beneficiaries. 

Under general supervision, this position assists the Program Director in performing the day-to-day operations of the Quality Improvement Organization (QIO) contract with the Centers for Medicare and Medicaid Services (CMS), which is designed to make care safer, promote effective coordination of care, promote preventive care, and help communities support better health, reduce costs of care through continual improvement, and promote person- and family-centered care. 


In this role, you would provide technical assistance to healthcare providers for readmission reduction and improved care coordination initiatives across the continuum of care. It is essential to possess a strong working knowledge of the CMS readmission reduction initiatives across provider settings. Under the guidance of the Director, typical responsibilities include:

  • Manages tasks associated with establishing community coalitions consisting of hospitals, nursing homes, home health, various community-based organizations, and other influencers to reduce readmissions and improve care coordination.
  • Performs assessments through interviews, on-site visits and observations to identify gaps in processes and then provides guidance on interventions that may impact the gaps identified. This includes interpreting data, using problem solving techniques and quality improvement skills (i.e., root cause analysis, fishbone, flow diagrams, etc.), accessing evidenced based resources, and develop corresponding action plans and strategies.  
  • Prepares and delivers presentations to community and C-suite providers meetings that includes skills in data analysis, meeting facilitation, conducting group interactive activities, distribution of education materials and meeting format (agenda, evaluations, save-the dates, CEU forms, etc.).
  • Documents activities related to the technical assistance provided (details about site-visits, meetings, communication, presentations conducted, and providers assisted).
  • Participates as a team member in the development and maintenance of standardized resources and reports and program milestones utilizing principles of project management.
  • Strong, collaborative team player, able to rise to the occasion to meet stretch goals as a group, and oriented toward activities to help the team function more efficiently and more collaboratively.
  • Remains current and knowledgeable about new initiatives, activities, opportunities, tools, and techniques through research, training, education, and a variety of nationally recognized sources.
  • Willing to travel throughout the state to work with providers and occasionally in other QIN states (if needed) in order to achieve contract goals.
  • Maintains current contract knowledge, the contract metrics and conducts the activities needed that must be met in order to satisfy the contract terms.
  • Participates in contract related webinars and trainings.

Job Requirements


  • The ideal candidate will be an experienced health care professional with a bachelor's degree or higher in nursing, public health or health related discipline.
  • Two or more years of health care experience in a hospital and/or skilled nursing facility environment specific to care coordination or working knowledge of discharge process and planning and appropriateness of post-acute services. 


  • High level of comfort with client interaction; maintains a strong customer focus.
  • Familiar with federal and state regulatory standards for hospitals and other care providers that are in the communities we are working with.
  • Proficient in Microsoft Office preferred- Word, Excel, Outlook, Project and Power Point and Webex.
  • Proficient in oral and written communication and interpersonal skills.
  • Familiar with evidence care coordination programs such as Project RED (Re-Engineered Discharge), Project BOOST (Better Outcomes for Older adults through Safe Transitions), CTI (Care Transitions Intervention), and/or INTERACT II (Interventions to Reduce Acute Care Transfers) 


The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 


This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with the position. While this is intended to be an accurate reflection of the current position, management reserves the right to revise the position or to require that other or different tasks be performed when circumstances change (e.g., emergencies, changes in personnel, work load, rush jobs requiring non-regular work hours, or technological developments). 

HSAG is an EEO Employer of Veterans protected under Section 4212. 

If you have special needs and require assistance completing our employment application process, please feel free to contact us. 

EOE M/F/Disability/Veteran