Quality Improvement Project Coordinator (Remote)

Description The Quality Improvement Department is committed to assessing current systems and processes to ensure the continuous improvement and regulatory compliance of overall health service delivery. This position is responsible for identifying, implementing, and overseeing projects relating to quality improvement/compliance initiatives in one or more of the following primary areas: CMS Five-Star Rating System and the Quality Rating System (QRS) Marketplace Exchange Quality Rating Systems (QRS) NCQA Accreditation and state regulatory compliance

HEDIS

ESSENTIAL RESPONSIBILITIES

Thoroughly reviews data, trends, and best practices to identify projects and approaches toward achieving excellence in area(s) of focus, including regulatory compliance, a 4 to 5 Star Rating in the CMS STAR Rating System, a 4 to 5 star rating in the QRS Rating System, and compliance with NCQA Accreditation standards and guidelines. Leads focused workgroups to identify areas of improvement, develop and implement QI strategies, and ensure compliance with regulatory/accreditation bodies. Tracks progress and coordinates recommendations from workgroup members. Reports progress and workgroup recommendations to leadership and appropriate committees, and progress on initiatives to the Quality Management Committee. Interfaces and coordinates efforts with various departments/vendors/contracted partners to develop and implement strategies that will address overall quality improvement, ensure compliance with regulatory requirements (NCQA, HEDIS, CMS, DOH, QRS), and align with corporate priorities. May serve as primary contact for the organization with regulatory bodies as it relates to reporting requirements and quality management/improvement/assurance. Participates in BlueCross and BlueShield Association Quality workgroups. Coordination of annual review of corporate administrative policies and procedures related to quality, accreditation and regulatory compliance. Manages projects and initiatives within the area of Health Care Quality Improvement & Reporting as needed. Other duties as assigned or requested.

EXPERIENCE

Required 5 years of healthcare-related work experience 3 years of experience managing projects Preferred 3 years of experience in accreditation and regulation

SKILLS

Knowledge of care management, managed care, health insurance industry, and the provider community. For Accreditation & Regulatory focus, thorough knowledge of DOH and CMS regulations and the reporting requirement components. Excellent verbal and written communication skills Ability to work effectively and manage multiple projects with minimal supervision High degree of business maturity and demonstrated confidentiality Strong organizational and leadership skills with the ability to manage multiple conflicting priorities Demonstrated personal accountability Excels in a team environment Project management or process improvement experience MS Word, Excel, PowerPoint Strong presentation skills Knowledge of Medicare processes/systems is a plus

EDUCATION

Required Bachelor’s degree in business administration or healthcare administration or relevant experience and/or education as determined by the company in lieu of bachelor's degree. Preferred Masters degree in business administration or healthcare administration LICENSES or CERTIFICATIONS Required None Preferred None Language (Other than English) None Travel Requirement 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type: Office- or Remote-based Teaches / trains others: Occasionally Travel from the office to various work sites or from site-to-site: Rarely Works primarily out-of-the office selling products/services (sales employees): Never Physical work site required: No Lifting: up to 10 pounds: Constantly Lifting: 10 to 25 pounds: Occasionally Lifting: 25 to 50 pounds: Rarely Pay Range Minimum $57,700.00 Pay Range Maximum $107,800.00 Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at #J-18808-Ljbffr Highmark Health