Quality Management Consultant

Wellmark   •  

Des Moines, IA

Industry: Healthcare IT

  •  

5 - 7 years

Posted 351 days ago

Job Summary

Wellmark is hiring a Quality Management Consultant to coordinate and support quality management (QM), accreditation and compliance activities. This individual will manage core processes and QM activities in an effort to support member health improvement, successful HEDIS submissions, and assuring compliance with regulatory rules and accreditation standards. Additionally, this individual will serve as a resource and subject matter expert to all levels within the organization on QM, HEDIS and compliance activities.

 

This particular opening will ensure organizational compliance with NCQA, state, and federal requirements, along with internal policies and procedures; with a focus on HEDIS. The incumbent will develop program material, manage the completion and delivery of program documents according to strict timelines, work closely with internal business partners and external stakeholders and manage the HEDIS submission process. Prior experience is desired in the areas of NCQA and HEDIS standards and accreditation, identification and execution of best practices, and/or proven experience in program management that resulted in high performance outcomes.

 

Core Competencies:

  • Accountability: Owning and taking responsibility for one’s actions.
  • Business Acumen: Understanding industry, market, financial and company specific operations.
  • Collaboration and Communication: Working together; listen to other’s ideas; communicate accurately and concisely.
  • Decision Making: Consider all facts and impacts when making decisions.
  • Focus on the Customer: Consistently doing what is in the best interest of our customer. Leaving a positive impression on the customer by elevating their experience; making it simpler and educating to helping them understand.

Minimum Qualifications Required (all must be met to be considered)

Bachelor's Degree or direct and applicable work experience.

  • 4+ years of work experience in a utilization management, quality management, accreditation coordination, or related role from within a clinical, health care delivery, managed care, or similar setting.
  • 1+ year of health insurance operations or related industry experience, including exposure to quality assurance principles or techniques.
  • Ability to review standards, business policies and procedures, health care literature, and/or medical cases. Must be able to draw defensible conclusions from available information.
  • Knowledgeable in regulatory standard or regulation review – e.g. URAC, NCQA, accreditation standards, confidentiality, state/federally mandated processes, etc.
  • Excellent analytical, diagnostic problem solving skills. Strong attention to detail and the ability to identify, research, and analyze issues, organize information, and make appropriate decisions. Ability to view the “big picture” when making decisions.
  • Demonstrated success in roles that require strong time management and workflow management skills. Ability to prioritize effectively and manage multiple projects.
  • Strong written and verbal communication skills with the ability to communicate and/or present complex information to stakeholders. Ability to negotiate if needed.
  • Proficiency with Microsoft Office applications, specifically Excel. Ability to run reports, construct documents, organize data, etc.



 

Hiring Specifications Preferred

  • Master's Degree.
  • Active and unrestricted RN license in Iowa or South Dakota.
  • CPHQ certification.
  • HEDIS experience.

  Job ID 212675