Compliance Quality Improvement Coordinator

Compliance Quality Improvement Coordinator

Develops, implements, and coordinates a compliance program to ensure conformity with accreditation and regulatory requirements specifically:

• NCQA Health Plan Accreditation for applicable products
• NCQA Health Equity Accreditation for applicable products
• NCQA Accountable Care Organization in support of the medical group
• MDH Quality Examination
• Oversight management of NCQA accredited functions
• Coordinates and supports other regulatory/accreditation functions as needed

Performs on-going assessment and facilitates cross functional process to ensure organizational compliance with the National Committee for Quality Assurance (NCQA) accreditation requirements for all NCQA accreditation standards and compliance with delegation oversight and compliance with Minnesota Department of Health and State rules and regulations.

ACCOUNTABILITIES:

1. Performs on-going assessment and facilitates process to ensure organizational compliance with the NCQA accreditation requirements including delegations and Minnesota Department of Health Quality Audits.
2. Facilitates workgroup meetings to communicate requirements, problem solve issues and coordinate processes to ensure organizational compliance with the NQQA accreditation, MDH and other regulatory requirements.
3. Communicates requirements to accountable business leaders and management staff.
4. Acts as a resource to staff regarding NCQA accreditation and MDH requirements and NCQA delegation.
5. Maintains a knowledge base of accreditation, regulatory and external customer requirements as they pertain to quality and utilization improvement within the managed care environment.
6. Coordinates the NCQA Accreditation Site Visit and MN Department of Health (MDH) Quality Assurance audits.
7. Coordinates mock audits and monitors for timely follow-up with corrective action plans.
8. Participates in CMS and DHS audits related to quality improvement.
9. Monitors relevant laws, rules and regulations with the assistance of legal and government relations.
10. Assists Manager in the selection of consultants, facilitates the use of internal and external consultants.
11. Represents the health plan's quality and utilization improvement activities to external regulatory entities, which have operational impact (i.e., DHS Technical Quality Committee, Stratis Health).
12. Coordinates the delegation site visits and annual and semi-annual reporting.
13. Facilitates workgroup meetings to ensure organizational compliance with the delegation agreements.
14. Coordinates the annual review of Policies and Procedures specific to the implementation of quality improvement activities and procedures, utilization analysis and clinical performance measurement within the health plan.
15. Establishes and maintains positive relationships with key management staff, medical director leadership and internal departments.
16. Coordinates activities to write/prepare reports related to NCQA and regulatory requirements.
17. Performs other duties as assigned.

REQUIRED QUALIFICATIONS:

• Bachelor's Degree or equivalent experience
• Three to five years experience working in a healthcare or business environment
• Excellent organizational, problem-solving and communication skills with demonstrated ability to present and explain complex information clearly
• Effective project management experience
• Good follow through and problem-solving skills and attention to detail
• Knowledge of Health Plan operations
• Ability to be proactive, take initiative and oversee projects
• Ability to manage, monitor and upload audit documentation.
• Strong written and oral communication skills

PREFERRED QUALIFICATIONS:

• Direct work experience in compliance and regulatory matters.
• One to two years Monitoring and Compliance Coordinator experience within a health care organization
• Demonstrated experience with compliance with NCQA Health Plan and Health Equity standards and NCQA survey process
• Experience with state and federal health care compliance and quality audits.
• Knowledge of HealthPartners operations
• Experience with process improvement projects including developing monitoring plans and conducting qualitative and quantitative analysis.
• Background with basic principles of population health, identifying health disparities and closing disparity gaps across sub-populations

DECISION-MAKING:

• Refers issues identified in the course of monitoring to the appropriate Department Management
• Reviews appropriate regulatory, contractual and operational considerations before giving direction on program compliance.
• Confers with Quality and Compliance Manager and other management on material/significant policy or regulatory changes.