Position Purpose: Lead and direct process improvement activities that provide more efficient and streamlined workflow.
Responsible for leading and collaborating with others on National Committee for Quality Assurance (NCQA) Accreditation and/or Healthcare Effectiveness Data and Information Set (HEDIS) performance
Responsible for quality improvement aspects of risk adjustment processes for all products
Collaborate with Medicare STARS team to improve overall STARS ratings for Medicare products (including HEDIS, CAHPS, HOS)
Oversee provider satisfaction surveys and implement action plans for improvements
Research and incorporate best practices into operations
Organize and control activities, methods, and procedures to achieve business objectives
Review and implement new technological tools and processes and fosters team concept with internal and external constituencies
Present results of improvement efforts and ongoing performance measures to senior management
Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines Qualifications:
Bachelor's degree in Nursing, related clinical degree or equivalent experience. 7+ years of quality management, quality improvement or healthcare operations experience. Masters’ degree preferred.
License/Certificates: Certain states may require a formal certification in quality improvement, risk management, or another parallel field. Current state’s RN license preferred. Certified Professional in Health Care Quality preferred.
Job ID 1132792