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Quality (HEDIS) Improvement Specialist

2 months ago

Scottsdale, United States Equality Health Full time
Job DescriptionJob Description

About the Organization:

Equality Health, LLC is a Phoenix-based whole-health delivery system focused on transforming value-based care delivery with population specific programs that improve access, quality, and member trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. Through an integrated technology and services platform, culturally competent provider network and personalized care model, Equality Health helps managed care plans and health systems improve outcomes for diverse populations while simultaneously making the transition to risk-based accountability.

Position Summary:

The Quality (HEDIS) Improvement Specialist assists leading our quality program for our Q Point division – developing short-term quality strategies and implementing quality improvement initiatives, (e.g., PIPs, QIPs) to meet contractual targets and key performance indicators (KPIs). This individual will evaluate quality and utilization data including tracking, monitoring, and addressing progress toward quality and utilization targets. This individual will serve as a key project management role for quality improvement projects (HEDIS/STARS) and campaigns.

Responsibilities:

  • Collect, analyze and report on quality performance measurement data, including quality measures within CareEmpower®
  • Collaborate with the Practice Performance team to inform and educate and meet quality goals of the organization (e.g., AHCCCS MPS, HEDIS, and STAR)
  • Review data to identify trends and opportunities for improvement
  • Maintain daily productivity per Department protocol
  • Maintain current up-to-date information on internal tracking tools
  • Request and follow-up on requested clinical documentation records from provider practices, vendors, and specialists to address open care opportunities
  • Conduct chart mining activities and abstraction via 3rd party platforms
  • Maintain an up-to-date knowledge of all quality programs that Equality Health administers and the quality metrics in which the company participates in with health plans and other payer incentive programs that may develop over time
  • Maintain accurate and current documentation of all active quality programs
  • Work directly with the division Sr. Quality Director and Sr. Vice President regarding the development of quality programs and to improve the capture of clinical quality measures to meet quality goals
  • Assist in the identification and facilitation of quality improvement programs designed to achieve quality, utilization, population health, health disparities and contractual metric goals
  • Stay abreast of primary health care practice standards – STARS, HEDIS, and RAF
  • Seek information to ensure current knowledge on federal programs, reporting requirements and upcoming healthcare initiatives
  • Collaborate with HealthBI to ensure CareEmpower® is continuously updated to meet the needs of the quality program
  • Ensure adherence to department and organizational standards, policies and procedures
  • May be required to work outside of regular business hours as necessary

Required Knowledge, Education & Experience:

  • Bachelor’s degree in Nursing, Social Sciences, Healthcare Administration or a related field of study; or, an equivalent combination of education, certifications and experience
  • Minimum of two (2) years of managed care experience with responsibility for quality improvement, quality data analysis, HEDIS and STARs
  • Experience with Medicaid, Medicare Advantage and/or marketplace products
  • Proficiency with Microsoft Office applications with intermediate to advanced expertise in Excel, and using web-based technologies to produce optimal quality HEDIS/STARS data
  • Demonstrated understanding of quality, risk and value-based contracting
  • Successful record of managing multiple projects with demonstrated ability to work independently in matrixed and rapidly-changing environments
  • Excellent verbal, written and interpersonal communication skills; highly collaborative team approach to work

Highly Preferred Skills, Abilities & Qualifications:

  • Demonstrated leadership abilities and skill in critical thinking, strategic planning, analysis and systems thinking
  • Strong health quality background with a deep understanding of quality improvement strategies, health organization quality management operational standards
  • Behavioral health experience
  • Demonstrated experience in a quality program that meets industry accreditation standards and supports organizational goal of delegation
  • Experience with clinical documentation and risk adjustment documentation review
  • Bilingual; able to read, write and speak Spanish and English

Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.