Manager, Quality Member Experience (52646)

GLOBALHEALTH HOLDINGS LLC•Oklahoma City, OK

2d•Remote

About The Position

Provides guidance, and training to the Quality department and organization-wide staff that impact member experience improvement initiatives. This position will ensure the effective management of member experience survey ratings, including member and provider outreach.

Requirements

Bachelors degree or equivalent experience required
5-years experience in a clinical or health insurance setting required
5-years experience managing data to create reports required
Requires a valid state Drivers License
Ability to communicate and manage complex working relationships
Ability to train internal and external parties
Strong organizational, verbal, written, time management, and telephone skills
Computer literate and familiar with Microsoft applications (Word, Excel, Outlook)
Basic electronic health record knowledge and ability to quickly learn new software
Detailed knowledge of quality performance measures and clinical health care
Ability to collaborate across departments

Nice To Haves

Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred

Responsibilities

Develops, plans, and implements initiatives and other quality member experience improvement strategies, making recommendations for change as needed.
Directs the member experience processes to ensure the health plan is NCQA-accredited and is a 4+ STAR rating.
Ensures pre-CAHPS member surveys are fielded on a monthly basis and communicates results with external provider groups.
Build and maintain relationships with other departments internally, as well as external provider groups, as it relates to STARS and NCQA.
Implements survey improvement initiatives including CAHPS committee meetings to ensure company-wide involvement to increase member survey scores.
Creates wellness materials for marketing distribution to aid in member retention and health improvement efforts.
Maintains an expert technical understanding of HEDIS, CAHPS, HOS, NCQA and Meaningful Use measures set by CMS performance standards.
Manages and monitors performance for CAHPS/HOS survey vendor.
Develops and implements Medicare AWV/HRA program to increase provider and member participation.
Sets actionable and achievable goals for Quality Department implementation toward earning and maintaining a 4 STAR.
Creates training material on member experience surveys for organization-wide staff.
Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
Performs other duties as assigned.