Quality Performance Specialist

Amerihealth Caritas Health Plan Philadelphia , PA 19107

Posted 1 week ago

Responsibilities:

As part of the Quality Management team, the Quality Performance Specialist is responsible for the coordination and ongoing monitoring of QI program objectives, including the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and facilitating HEDIS, CAHPS and NCQA accreditation activities. Implements and supports the overall implementation of quality programs that meet or exceed applicable State, Federal and NCQA standards.

Principal Accountabilities:

  • Executes on organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting body's standard requirements.

  • Responsible for completion and analysis of annual HEDIS results and works with all areas to integrate results into departmental goals.

  • Responsible for the successful development and evaluation of an annual QI work plan and program description by facilitating QI throughout the organization.

  • Identifies resolves and/or escalates problematic QI areas that may place plan at risk of not achieving annual goals.

  • Collaborates with Provider Services and Member Services to complete analysis of annual satisfaction surveys and works with all areas to integrate results into departmental goals.

  • Participates in the development, implementation and maintenance of QI policies and procedures.

  • Serves as a resource to other departments in completing QI goals.

  • Works professionally and efficiently with all functional areas in meeting organizational and departmental quality goals.

  • Participates on QI committees structured to achieve outcomes success and completes committee documentation that is consistent in meeting regulatory and accrediting body requirements.

Education/Experience:

  • Associate's Degree or equivalent work experience required. Bachelor's Degree preferred.

  • Minimum of 3 years in clinical or service quality improvement required

  • Minimum of 3 years in healthcare delivery required.

  • Managed Healthcare experience preferred.

  • Successful management of NCQA accreditation survey preferred

  • Excellent organizational, analytical and interpersonal skills.

  • Excellent written and verbal communication skills.

  • Ability to work successfully within all levels of the organization.

  • Ability to design, develop and implement projects to address financial, quality and service improvements.

  • Proficient PC skills in a windows based environment.

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Quality Performance Specialist

Amerihealth Caritas Health Plan