HEDIS Quality Improvement Specialist, remote Job at AllWays Health Partners
HEDIS Quality Improvement Specialist, remote
(Job Number: 3215571)
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
The Quality Improvement Specialist is responsible to coordinate health plan-based quality improvement projects and assist practice sites with the design and implementation of quality improvement objectives. The target focus for quality improvement include the HEDIS preventive and chronic disease management measures, patient satisfaction (CAHPS) and patient access.
Essential Functions
Quality Improvement Project Management
Quality Improvement Project Management
- Under the direction of the Manager of QI Programs, lead the creation and execution of the Quality Management Program Description, the Quality Management Workplan and the Quality Management Evaluation
- Provide oversight and direction on the execution of the Quality Management Workplan, ensuring all quarterly updates are complete, accurate and timely. Identify barriers to the workplan as well as solutions on an ongoing basis and ensure the Manager of QI Programs is kept abreast of all issues.
- Lead and assist QI workgroups across a variety of clinical and non-clinical areas including health promotion and disease management, member satisfaction, and behavioral health. Identify opportunities to leverage new and existing resources both in house and externally with the goal of improvement outcomes and performance.
- Consult and co-lead the medical and behavioral health quality improvement strategies in place for our Exchange or Qualified Health Plan population.
- Provide leadership and guidance to outside vendors, consultants and stakeholders who assist the department in reaching our deliverables and goals
- Participate in any external audits by state auditors or accrediting agencies, providing support and leadership where needed as directed by the Manager of QI Programs or his/her supervisors.
- Prepare workflows, performance improvement project (PIP) reports and other documentation to meet internal and external regulatory requirements
- Prepare routine and ad-hoc performance and activity reports using trended data.
- Provide technical assistance to provider practice sites in achieving clinical and service quality improvement goals.
- Participate in focus meetings with providers regarding individual site level performance against established goals.
- Effectively present and represent Mass General Brigham Health Plan’s interests externally to providers and other stakeholders.
- Effective present and respond to inquiries from employees, senior management and regulatory agencies.
- Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort
- Remote work.
- Occasional meetings outside the office are required.
Knowledge and Education
Required:
- Bachelor’s Degree plus 5-7 years of health plan-related experience.
Preferred/Desired:
- Master’s Degree in Public Health preferred
- Medicaid/Medicare quality management experience preferred
Required:
- Minimum of 5 years leading quality improvement teams/efforts in either a provider practice or health plan.
Preferred/Desired:
- Project Management certification preferred.
Skills/Competencies
- Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value.
- Bring fresh ideas forward by listening to and working with employees and the people we serve.
- Strong aptitude for technology-based solutions.
- Ability to inject energy, when and where it’s needed.
- Respect the talent and unique contribution of every individual and treat all people in a fair and equitable manner.
- Exercise self-awareness; monitor the impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
- Be accountable for delivering high-quality work. Act with a clear sense of ownership.
- Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
- Excellent critical thinking, analytical and organizational skills
- Proficient in Microsoft Office products
- Proficient in Visio or other flowcharting applications
- Proficient in internet research
- Ability to work well both independently and in a team.
- Excellent oral and written communication skills
- Meticulous attention to detail
- Business writing and presentation skills; ability to write clear, concise reports, proposals and business correspondence
- Ability to influence others and persevere in situations
- Ability to initiate administrative activities as necessary and institute quality control procedures.
- Ability to manage multiple projects, meet deadlines and adjust to changes in company policies, procedures and priorities.
- Ability to read, analyze and interpret clinical research, general business periodicals, professional journals, government regulations and legal documents.
- Ability to effectively present and represent Mass General Brigham Health Plan’s interests externally to providers and other stakeholders
- Ability to effectively present information and respond to inquiries from employees, senior management and regulatory agencies
Action
- Provides technical assistance to business owners on all new business and assists them in the evaluation of gaps and corrective action plans.
- Lead inter-disciplinary workgroups ensuring project goals are met.
Organizational Relationships/Scope
- Reports directly to the Manager, Quality Improvement and ensures the department goals set forth by the Director and Chief Medical Officer are met.
- Work collaboratively with others across all departments and with providers at practice sites.
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