Location: Chattanooga, TN
Duration: 6 Months
- Working knowledge of HEDIS performance specifications and recommended best practices.
- Knowledge of development and implementation of aligned quality associated strategies and plans as well as facilitation of engagement strategies associated with the achievement of the plan, including effectively utilizing resources.
- Coordinate performance improvement reporting audit program to ensure the accuracy and compliance with regulatory guidelines and requirements (URAC, NCQA, CMS, and EQRO) in a reporting environment.
- Examine and analyze reports to ensure the accuracy and compliance with effectiveness.
- Coordinate delivery of data within the company for use in document review.
- Perform clinical information research within national guidelines and published standards as assigned by manager and produce accurate document of findings for review.
- The incumbent is accountable for assuring that the State Government Medical Management Department is positioned to utilize the most advanced data analytics and reporting for accreditation/regulatory/contract compliance.
- This position is responsible for supporting the design, development, implementation, and management analysis of programs and reports to improve the outcomes within the division.
- The Performance Improvement Consultant also plays a leadership role in analytic projects to improve day-to-day operations and improve effectiveness, timeliness and quality of data provided.
- Manages the day-to-day operational scope and various aspects of projects by analyzing current processes for efficiency and effectiveness.
- Incumbent must have a working knowledge of Facets, CareKey, CareAdvance and other systems and processes utilized
- Interact and communicate with all levels of staff in the division regarding project assessment and status.
- Coordinate performance improvement activities to ensure the accuracy and compliance with.
- Regulatory guidelines and requirements (URAC, NCQA, CMS, and EQRO) in a reporting environment.
- Develop, examine and analyze programs reports to ensure the accuracy and compliance with effectiveness.
- Coordinate delivery of data and information within the company for use in document review.
- Produce, validate, and deliver accurate and presentation quality reports as well as accurate and meaningful ad hoc reports from verbal and written requests.
- Maintaining existing reports and schedule report productions.
- Drive the adoption of self-serve reporting and query tools by working with internal customers.
- This requires training, demonstration of existing tools and development of new reports to meet internal customer needs.
- Effectively analyze and communicate results.
- Develop/modify reports using MS Access, Excel and other Enterprise Reporting tools.
- Direct and recommend actions designed to achieve quality and productivity improvement goals and improve inter-departmental communications based on Report findings.
- Maintain a working knowledge of laws, regulations, rules, contractual provisions, processing guidelines, accreditation standards, consent decrees, and corporate procedures that affect the member’s access to the healthcare system.
- This will protect interests in terms of contractual and regulatory compliance standards so as not to become subject to financial penalties and/or legal exposure.
- Keep management apprised of all project requests and work involvement with other departments.
- Minimum of a Bachelor’s Degree in Business, Nursing, Education or a health related field required OR a minimum of 6-8 years experience in the healthcare insurance industry.
- Master’s level preferred.
- Experience in working with regulatory guidelines and requirements (URAC, NCQA, CRA and EQRO) in a reporting environment.
- Must have working knowledge of Utilization management/Case Management
- Strong analytical skills and ability to take disconnects in communication and data to comprehensively piece them together, providing an accurate picture of the improvements necessary to the success of programs and initiatives
- Must show excellent interpersonal and communication skills in order to effectively interact with company staff at all levels.
- 2-3 years of project management experience and attention to detail is required.
- Must show the ability to establish and maintain strong relationships with customers at all levels, inter-divisional leaders as requested by the management.
- Self directed with excellent interpersonal, communication (written and oral), presentation, problem-solving, planning, and organizational skills required.
- Competent in Word, Excel, and PowerPoint.
Positions Specific – VSHP Clinical Quality Improvement Job Duties & Responsibilities:
- Responsible for implementation of the quality improvement process and infrastructure
- Responsible for the contractual quality improvement related deliverables for the program including but not limited to the Program Description, Annual Quality Work Plan, Annual Program Evaluation and Performance Improvement Projects (PIPs).
- Evaluates and analyzes measurement of performance; ensures appropriate reports are in place to support quality program monitoring and evaluation
- Identifies, analyzes and tracks all quality measures outliers and collaborates with Team to ensure an appropriate action plan is implemented to achieve improved performance.
- Implements a management control plan for improved measures, with particular focus on those clinical quality measures that carry financial risk.
- Manage and ensure that corrective and preventive action activities are effective throughout all functional areas; and, that follow-through maximizes the effectiveness of the system.
- Coordinate the development and implementation of aligned quality associated strategies and plans and facilitation of the engagement strategies associated with the achievement of the plan, including effectively utilizing resources.
- Partner with appropriate interdisciplinary team to develop new programs and/or program innovations providing support and guidance around program design, polices, and procedure, and the development of a performance management infrastructure.
- Provide oversight of the analysis and identification of health care disparities while coordinating associated quality programs and initiatives designed to address and reduce health care disparities
- Provide oversight and coordination of inventories related to current and new quality programs, initiatives, and strategies.
- Represent Quality Department at applicable Enterprise Quality Committees and sub-committees providing updates and information as requested on new and existing quality improvement initiatives and facilitate discussion to address quality improvement needs.