Sr. Quality Process Improvement Specialist

Dignity Health Bakersfield , CA 93301

Posted 8 months ago

Overview Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

What We Offer

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

  • This position will report to the: Director, Quality Management

  • Percentage Travel Required/Frequency: 10%

  • FLSA Status: Exempt

  • Remote Worker: Non-eligible

Responsibilities What You'll be Responsible For in this Role Your Contribution & Career Journey

In this role, the Senior Quality Process Improvement Specialist supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies that impact plan compliance to regulatory and accreditation standards.

What We're Looking For

  • Establishes and/or revises existing policies and procedures necessary for successful implementation of the Quality Improvement (QI) Program

  • Pursues methods to ensure receipt of relevant data, as required for accurate trending of various QI work plan metrics

  • Analyzes key plan metrics, such as top diagnoses, clinical procedures, and operational performance

  • Works with QI Director to convene various QI committees and work groups, set agenda to drive desired meeting outcomes, and ensure proper recording of committee activities

  • Acts as a knowledge expert for continuous quality improvement activities, educating staff of other functional areas regarding the QI process and accreditation requirements

  • Performs various quality department functions and processes

  • Manages and monitors clinical quality studies

  • Recommends strategies to improve member compliance to QI program activities

  • Recommends methods to improve network provider compliance to health plan QI Program policies and procedures

  • Fields annual member and provider satisfaction surveys, working with vendor to clarify results and present findings and recommendations to senior leadership

  • Assists with efforts to secure successful NCQA accreditation


Minimum Qualifications:

  • Bachelor's degree in nursing or a related health field or equivalent years of related experience; Master's degree in a related field may be considered in lieu of experience

  • 2-4 years of HEDIS experience

  • 5+ years of experience in a healthcare delivery organization, such as a managed care organization or a hospital environment

  • 3+ years of experience in QI, performing a wide range of functions with strong focus on data analysis and initiation of improvement initiatives

  • 3+ years of experience in process improvement and project management

  • Knowledge of Medicaid and/or Medicare programs

Additional Required Qualifications

  • Manages and monitors clinical quality studies

  • Recommends strategies to improve member compliance to QI program activities

  • Recommends methods to improve network provider compliance to health plan QI Program policies and procedures

  • Fields annual member and provider satisfaction surveys, working with vendor to clarify results and present findings and recommendations to senior leadership

  • Assists with efforts to secure successful NCQA accreditation

  • Strong technical skills

  • Intermediate Knowledge with Microsoft: Word and Excel

Preferred Qualifications

Refer to Minimum Qualifications

Equal Employment Opportunity

We are an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as need, to assist them in performing essential job functions.

Recruitment Agencies

Dignity Health Management Services Organization does not accept unsolicited agency resumes. Dignity Health Management Services Organization is not responsible for any fees related to unsolicited resumes.

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Sr. Quality Process Improvement Specialist

Dignity Health