Position Purpose:
- Lead and direct process improvement activities that provide more efficient and streamlined workflow
- Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare
- Effectiveness Data and Information Set (HEDIS) performance
- Responsible for quality improvement aspects of risk adjustment processes for all products
- Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
- Oversee provider satisfaction surveys and implement action plans for improvements
- Research and incorporate best practices into operations
- Organize and control activities, methods, and procedures to achieve business objectives
- Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
For PA H&W Only:
- Responsible for overseeing reporting and outcome measurement and HEDIS data collection, serving as point person between the department and the department’s EQR contractor
License/Certificates:
- Certain states may require a formal certification in quality improvement, risk management, or another parallel field
- Current state’s RN license preferred
- Certified professional in healthcare quality preferred
Non-Negotiable Requirements:
- Lead and direct process improvement activities that provide more efficient and streamlined workflow
- Bachelor’s degree in Nursing, related clinical degree or equivalent experience
- Masters degree preferred
- 7+ years of quality management, quality improvement or healthcare operations experience
- Leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance Quality improvement aspects of risk adjustment processes for all products
- Prior work with Medicare management