POSITION SUMMARY/RESPONSIBILITIES
The Liaison, Clinical Performance Improvement and Reporting, serves as a key leader in driving continuous quality improvement, regulatory compliance, outcomes evaluation, and performance reporting across the organization. This position is responsible for leading the development, implementation, monitoring, evaluation, and reporting of Health and Human Services Commission (HHSC) Performance Improvement Projects (PIPs), Quality Assurance and Performance Improvement (QAPI) activities, and National Committee for Quality Assurance (NCQA)-required program documentation and evaluations, also known as the Quality Improvement Program Plan (QIP) and the annual evaluation of the plan function and outcomes reporting, QIP Evaluation. Working collaboratively with Quality Management, Population Health, Clinical Operations, Medical Management, Behavioral Health, Service Coordination, Network Management, and Data Analytics teams, this role supports the development and maintenance of Utilization Management (UM), Case Management (CM), Behavioral Health (BH), Population Health Management (PHM), and Service Coordination (SC) program plans and annual evaluations. The Manager facilitates interdisciplinary improvement initiatives, analyzes clinical and operational performance data, identifies opportunities for improvement, evaluates intervention effectiveness, and ensures timely and accurate reporting of outcomes to executive leadership and regulatory agencies. This position serves as a strategic resource for performance improvement and quality management activities by translating data into actionable recommendations, promoting a culture of continuous improvement, ensuring adherence to HHSC, CMS, NCQA, HEDIS, and contractual requirements, and supporting organizational efforts to improve member outcomes, quality performance, operational effectiveness, and compliance.
EXPERIENCE
Bachelor's degree in Nursing is required. Master's degree in Nursing, Public Health, Healthcare Administration, or a related healthcare field is preferred. Thorough knowledge of managed care regulations and requirements from the Texas Health and Human Services Commission (HHSC), Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), HEDIS, quality improvement methodologies, population health management principles, accreditation standards, and healthcare program evaluation is required. Knowledge of statistical, analytical, and investigative techniques sufficient to identify outcome trends, evaluate intervention effectiveness, and support data-driven decision making is required. Experience in quality management, performance improvement projects, accreditation activities, population health, program evaluation, regulatory compliance, and healthcare reporting is strongly preferred. Strong project management, data management, analytical, written communication, and presentation skills are required.
LICENSURE/CERTIFICATION
Current Registered Nurse (RN) license to practice professional nursing in the State of Texas is required. Certification by a nationally recognized healthcare quality or performance improvement organization (e.g., CPHQ, CPHQ-PC, Lean Six Sigma, or equivalent) is preferred.
