Compliance Quality Improvement Coordinator

HealthPartners•Bloomington, MN

About The Position

HealthPartners is hiring for a Compliance Quality Improvement Coordinator. This role develops, implements, and coordinates a compliance program to ensure conformity with accreditation and regulatory requirements, specifically NCQA Health Plan Accreditation, NCQA Health Equity Accreditation, NCQA Accountable Care Organization, and MDH Quality Examination Oversight for applicable products and functions. The coordinator performs ongoing assessment and facilitates cross-functional processes to ensure organizational compliance with National Committee for Quality Assurance (NCQA) accreditation standards, delegation oversight, and Minnesota Department of Health (MDH) rules and regulations.

Requirements

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

Nice To Haves

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

Responsibilities

Performs ongoing assessment and facilitates processes to ensure organizational compliance with NCQA accreditation requirements, including delegations and Minnesota Department of Health Quality Audits.
Facilitates workgroup meetings to communicate requirements, problem-solve issues, and coordinate processes to ensure organizational compliance with NCQA accreditation, MDH, and other regulatory requirements.
Communicates requirements to accountable business leaders and management staff.
Acts as a resource to staff regarding NCQA accreditation and MDH requirements and NCQA delegation.
Maintains a knowledge base of accreditation, regulatory, and external customer requirements as they pertain to quality and utilization improvement within the managed care environment.
Coordinates the NCQA Accreditation Site Visit and MN Department of Health (MDH) Quality Assurance audits.
Coordinates mock audits and monitors for timely follow-up with corrective action plans.
Participates in CMS and DHS audits related to quality improvement.
Monitors relevant laws, rules, and regulations with the assistance of legal and government relations.
Assists Manager in the selection of consultants and facilitates the use of internal and external consultants.
Represents the health plan’s quality and utilization improvement activities to external regulatory entities with operational impact (e.g., DHS Technical Quality Committee, Stratis Health).
Coordinates the delegation site visits and annual and semi-annual reporting.
Facilitates workgroup meetings to ensure organizational compliance with delegation agreements.
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.
Establishes and maintains positive relationships with key management staff, medical director leadership, and internal departments.
Coordinates activities to write/prepare reports related to NCQA and regulatory requirements.
Performs other duties as assigned.