The position will involve a significant amount of regulatory and accreditation research as well as technical specification review to accurately educate and support key stakeholders in each quality program. The position will utilize new technology, as appropriate, for efficient delivery of services and to make informed decisions based on data, to drive performance metrics across all health plan performance initiatives.
The position will provide support with managing the development, implementation, compliance and oversight of Hometown Health's Quality Improvement Programs. Components of this position include NCQA Accreditation, Risk Adjustment, Stars, HEDIS, and Member Satisfaction. This position will perform other duties as requested.
The essential functions of the position are:
- Qualitative and Quantitative Analysis of key Quality and Health Plan Initiatives
- Collaborate and assisting with education to providers, office staff and internal stakeholders to increase engagement on all health plan performance initiatives that support regulatory requirements for programs such as HEDIS, NCQA, CAHPS, and Star Ratings.
- Ability to maintain effective working relationships with internal staff, physicians, other providers, staff, employers, regulatory agencies, and enrollees.
- Focus on closing care gap opportunities that support the health plan performance initiatives.
- Simultaneous action at varying stages-initiation, follow through, and completion-on a number of different projects.
- Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff.
- Ability to review, analyze and interpret regulatory requirements in a clear and concise manner.
- Implements surveillance activities to ensure all quality and regulatory standards are being met.
- Analyzes data collected and makes recommendations for process improvements.
- Assists in the education of new policies and procedures designed to enhance quality care and minimize patient, visitor, and employee risk.
- Provide comprehensive project management for quality improvement and regulatory initiatives.
- Demonstrate the ability to design and develop reports, documents and spreadsheets.
- Excellent organization and problem-solving skills as well as qualitative and quantitative analytical skills.
- Ability to work independently with minimal supervision.
- Coordination and management of Health Plan Quality Improvement Committees
This position shall participate all in quality improvement and change management procedures and processes.
This position does not provide patient care.
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