For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Role Overview:

The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions. The position is grounded in data analytics skills in order to work collaboratively with providers, members, and internal departments across the organization to conduct ongoing processes that identify opportunities for quality, service, and clinical improvement. Manages activities related to plan accreditation, preventive health improvement, business analysis, and clinical and service quality improvement, including state withholds, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Also supports the organization's quality improvement philosophy and promotes the use of quality improvement (QI) tools in decision-making.

Work Arrangement

• Monday through Friday, 8:30 AM to 5:00 PM
• Must work 4 out of 5 days a week at our AmeriHealth Caritas DC office located at1201 Maine Avenue, S.W., Suite 1000, 10th Floor, Washington DC 20024.
• Must reside in the DC metro area. Office is in close proximity to two metro stations.

Responsibilities:

• Provide key data analysis and critical thinking for the development and assessment of quality improvement project interventions.
• Develop reports and analyses, and present findings to the Quality Committee for input and direction.
• Support HEDIS and Clinical Practice Guidelines.
• Support accreditation activities and clinical quality performance improvement initiatives.
• Perform ad-hoc analyses of underperforming processes by collaborating with Subject Matter Experts (SME) and internal stakeholders to define current processes and recommend improvements.
• Remove barriers to ensure the successful completion of strategic quality projects.
• Conduct analyses and provide summary reports to senior management.
• Act as a primary liaison to internal departments requiring collaboration and coordination.
• Support the development of new and existing staff by identifying learning and training opportunities.
• Serve as a mentor to new hires, ensuring consistency in information and training.

Education & Experience:

• Associate's Degree or equivalent work experience required
• Registered Nurse (RN) required
• 5 years of experience in clinical or service quality improvement required.
• 5 years of experience in managed care required.
• Experience working within a managed care plan organization
• Experience managing National Committee of Quality Assurance (NCQA) accreditation surveys preferred
• Prior experience with project facilitation and/or project management preferred

Licensure

• Active and unencumbered Registered Nurse license in the District of Columbia

Skills & Abilities:

• Intermediate or Expert proficiency in Microsoft Excel or other data tools.
• Knowledge and understanding of quality improvement functions within a Managed Care Organization (MCO) preferred.
• Excellent written and verbal communication skills.
• Strong organizational, analytical, and interpersonal skills.
• Ability to work effectively across all levels of the organization.
• Ability to design, develop, and implement projects addressing financial, quality, and service improvements.

The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington D.C. area. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.

AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.

The targeted hiring range for this role is expected to be between $92,200.00 and $125,600.00