Summary of Job
Build relationships with external providers and vendors to create shared understanding of organizational quality goals. Identify, develop, execute and evaluate quality and process improvement projects in partnership with providers and/or vendors that support public health, HEDIS®, QARR, NCQA and other regulatory needs. Utilize tools to monitor and drive improvement in key quality Medicare STARS and Medicaid incentive measures with provider groups. Collaborate with colleagues in Provider Network and Product, Analysts, IT, Marketing and build cross functional teams to align strategies and priorities to achieve quality goals. Partner with department leadership to build upon and grow enterprise-wide provider quality improvement strategy. Ensure that gains are maintained by providers, and corrective actions are taken as necessary to ensure performance improvement and to support compliance with regulatory and accreditation bodies.
Responsibilities
• Maintain key relationships with providers, office staff and other external stakeholders.
• Establish consistent communication and collaboration structure with assigned provider groups.
• Build relationships with internal stakeholders (e.g. provider network, marketing) and create cross-functional teams to create a more streamlined experience for the provider.
• Create and align shared understanding of quality goals.
• Implement processes for two-way data sharing and work with quality data team to develop structure.
• Review performance dashboards, highlight opportunities and translate findings into actionable interventions.
• Monitor and track quality performance against provider contracts; make recommendations to contracts to ensure goal alignment.
• Prepare reports, presentations and executive level summaries to share projects, processes, results and highlight collaboration efforts.
• Create action plans and workplans to achieve performance improvement in HEDIS and CAHPS results.
• Create engagement and quality educational tools which providers can utilize in their office.
• Improve the understanding of quality measures through the use of educational programs (e.g. lunch and learns, webinars) and increase satisfaction and improved gap in care outcomes.
• Share and roll-out provider incentive programs.
• Ensure compliance with regulatory bodies and accreditation; implement corrective action and performance improvement projects as needed.
• Recommend best practices and evidence-based guidelines for care integration, preventive care, care coordination and patient experience.
Qualifications
• Bachelor’s Degree in a health services field (Required)
• Master’s degree in public health, public administration, social work, health services (Preferred)
• 3 – 5+ years’ experience in a health care related field, preferably managed care (Required)
• Quality improvement experience in a managed care environment (Preferred)
• Proficient in Microsoft Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
• Ability to develop cross-functional teams and work collaboratively with different levels of staff (Required)
• Familiar with and have a working knowledge with QI process improvement methodology strategies, e.g. PDSA (Required)
• Possess understanding of quality measures including HEDIS®, QARR, CAHPS (Required)
• Superior planning and organizational skills to collect, organize and present information clearly (Required)
• Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines (Required)
• Independent thinker; strong critical thinking and problem-solving skills (Required)
• Ability to travel to provider accounts and work with team members in several locations where the company has offices (Required)
• Experience with and proficient in reviewing and summarizing data into actionable and simple reports and presentations (Required)