Position Summary:
The Quality Improvement Specialist is responsible for quality and performance improvement activity within the Medicare STAR program, including project management, process improvement, campaign coordination, and outcomes measurement. This position has a specific focus on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, and member experience and satisfaction. The ideal candidate possesses a deep understanding of the CAHPS survey and its impact to Medicare STAR.
General Duties/Responsibilities:
(May include but are not limited to)
-Support the development and implementation of strategies to drive CAHPS performance improvement.
-Coordinate the planning and execution of member and provider initiatives and campaigns for the Medicare STAR program. This may include material development, outbound campaigns (mail/phone/email), case review, and other cross-functional initiatives to improve member experience and satisfaction.
-Track and report on outcomes and KPIs for the program to ensure progress is met throughout the various project life cycles. Conduct quantitative and qualitative analysis of initiatives to assess effectiveness.
-Assist in tracking projects and actions using designated operating and project plans.
-Responsible for formulating and executing all processes, requests, workflows or policies as requested by management in an efficient manner, including offering a proactive approach to suggestions and recommendations.
-Responsible for collecting data from various sources, such as EMR systems, the enterprise data warehouse (EDW), command center, and other internal and external data sources.
-Use critical thinking skills to solve a wide array of problems and use a solutions-based approach when presenting issues.
-Implement process improvements to streamline departmental functions.
-Preparation of meeting materials or training documentation as needed.
-Ensure patient privacy is protected by adhering to HIPAA standards, company policies and procedures, and other federal, state, and local requirements.
Minimum Requirements:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum Experience:
-Minimum 1-2 years of quality improvement, CAHPS, and/or Medicare STAR program experience required in a health plan, managed care, or medical group/IPA setting.
-Experience with improvement activities and tactics to influence member/patient perception and satisfaction.
Education/Licensure:
Bachelor’s degree (BA or BS) from four-year college or university is required. Health-related field (Health Science, Health Administration, or related) is preferred.
Other:
Proficient in Microsoft Office (Outlook, Excel, Work, PowerPoint required. Visio and Access are preferred) and familiar working with large data sets.
Knowledge of medical terminology and HIPAA.
Mathematical skills, attention to detail, problem-solving and analytical skills are essential.
Self-starter; able to work independently with minimal supervision.
Strong communications skills: written, verbal, and interpersonal
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.
On August 17, 2021, Alignment implemented a policy requiring all new hires to receive the COVID-19 vaccine. Proof of vaccination will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations. This policy is part of Alignment’s ongoing efforts to ensure the safety and well-being of our staff and community, and to support public health efforts.