Senior Quality Improvement Specialist

Profile

Senior Quality Improvement Specialist','Full-time','Professional Non-Clinical','Days','Days','80','80','None','None','WASHINGTON-FEDERAL WAY-FEDERAL WAY-HERON BLDG','','!*!Summary

The
Quality Improvement (QI) Specialist will support the various projects in the
Quality Improvement department as directed. Key
functions include coordinating and facilitating various projects to ensure that goals and objectives are
accomplished through judicious and efficient use of resources. Facilitate the
spread of excellent clinical and service quality for members of all Prominence
Health affiliated health plans. He/she will support the collection of metrics
and manage all quality improvement activities. He/she will support the
HEDIS data collection and reporting as well as initiatives for STAR Ratings
improvement.  Development and maintenance of effective working
relationships with internal and external partners is essential. This is
primarily an in-office position with normal business day hours. Limited travel
may be required.

 

Essential Duties and Responsibilities

1.      Provides
necessary assistance to
implement, monitor and support
Quality Improvement projects across all lines of business.

2.      Will lead or manage projects to
assure implementation of Prominence Health’s Quality Improvement work plan such
as improving quality metrics, population health management, CCIP and QIP.

3.      Supports
STAR Ratings and Risk Adjustment related activities.

4.     
Participate
and assist in the annual HEDIS Compliance audit, data
collection and medical record review process as necessary.

5.     
Contributes
to the preparation of annual program descriptions and evaluations.

6.     
Supports
developing and maintaining processes for activities within the QI department.

7.      Support
the resolution of Potential Quality of Care concerns.

8.      Assist in the development and
implementation of job specific policy and desk procedures.

9.      Identifies and assists in resolving
areas of non-compliance, and facilitates improvement and integration of
standards into work processes and systems.

10.  Liaison
between members and their providers to assist in closing gaps in care.

11.  Maintain
key quality metrics dashboard.

12.  Arrange and facilitate meetings and
calls as required by project deliverables including taking minutes.

13.  Maintain compliance in all activities
performed.

14.  Contribute
to team effort by accomplishing related results as needed.

15.  Demonstrates ability to utilize
project management skills - organization, priority setting, delegation, managing
multiple projects.

16.  Analyzes
and evaluates the effectiveness of project activities for results and outcomes
related to strategic goals.

17.  Conducts
necessary research and best practices to enable process improvement activities.

18.  Provides courteous and prompt service
to all internal and external customers. Prioritizes and addresses requests and
assignments in a professional manner to develop cooperative relationships

19.  Work
collaboratively and promote positive relations with Delegates, Vendors,
External Stakeholders, and other Departments and Committees as assigned.

20.  Performs other duties as assigned.

','!*!Education and Experience

·       
High school diploma or equivalent. Associates or Bachelor’s degree in
medical or health care management and/or nursing degree preferred.

·       
Certified Professional Coder (CPC) or Medical Record Review experience preferred.

·       
1 – 3 Years
of experience in the following:  Health
plan quality improvement, HEDIS - working knowledge of HEDIS medical record
review, medical coding, using electronic medical record systems, data
management & reporting.

·       
Data analysis
experience highly preferred.

·       
2-4
years demonstrated working experience with prepaid health care delivery systems
such as HMOs.

·       
Demonstrated
verbal, written and formal presentation skills.

·       
Demonstrated
competence with computer skills and skilled in using Microsoft applications Excel, Word, PowerPoint, Access,
Outlook and using the Internet.

·       
Working knowledge of medical terminology and procedures,
managed care products and programs, and National Committee for Quality
Assurance (NCQA) and/or other standards highly preferred.

·       
Ability to function effectively
within an ever-changing environment and to meet deadlines and reprioritize as
necessary.

·       
Ability to work both independently
and within a team environment and a multi-dimensional environment; Ability
to organize people or tasks.

·       
Creative, flexible, self-motivated,
professional must possess sound judgment ability to plan and initiate new
activities consistent with achieving service excellence.

·       
Excellent problem solving ability through
systematic analysis and sound judgment.

·       
Ability to collaborate and influence others
under positive or negative circumstances.

·       
Keen attention to detail with ability to
relate with larger goals and listen critically.

·       
Problem-solving orientation to identify root
cause, develops solutions, and implement in close collaboration with
those doing the work.

·       
Excellent, professional communications
(written and verbal) and interpersonal skills along with ability to prepare
written communications and presentations.

·       
Ability to write reports, business
correspondence and procedure manuals.

·       
Ability to effectively communicate
and present information in response to questions from all audiences.

·       
Excellent research, problem solving
and analytical skills. Must be able to formulate and recommend solutions.

 

Certificates, Licenses and Registrations

·       
None required but
experienced but nursing
or other healthcare background preferred.

·       
Certified Professional in Healthcare Quality
(CPHQ) and/or Certified Professional Coder (CPC) preferred.

·       
Pertinent
experience in lieu of above will be considered.','We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.','2017-R0143067','QualChoice Health','Senior Quality Improvement Specialist

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