Market Quality Improvement Specialist II

CareSource•Nevada WFH, NV

2d•$62,700 - $100,400•Hybrid

About The Position

The Market Quality Improvement Specialist II collaborates with department manager and other leadership to evaluate opportunities for HEDIS data and process improvement in new or existing projects with a focus on measurable benefits. This role is responsible for conducting business process and gap analysis, leading improvement work teams, and training staff on improvement tools and methodologies. The specialist will analyze work processes, establish measurement methods, and explore best practices to drive quality initiatives. They will also coordinate quality improvement committee meetings, communicate effectively with stakeholders, and monitor vendor performance. Additionally, the role involves preparing reports and deliverables for various programs and projects.

Requirements

Bachelor’s degree or equivalent years of relevant work experience is required.
Minimum of three (3) years of healthcare or managed care experience is required.
Knowledge of a variety of quality improvement methodologies – Model for Improvement, Lean, Six Sigma.
Proficient in leading teams through establishing aim statements and identifying small tests of change.
Proficient in establishing and documenting PDSA cycles and key driver diagrams.
Excellent team facilitation skills.
Ability to engage teams in a positive, energetic manner.
Research, data analysis and trending.
Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint.
Excellent written and verbal communication skills.
Ability to develop, prioritize and accomplish goals.
Ability to work independently and within a team environment.
Attention to detail.
Familiarity of the health care field.
Familiarity with applicable Federal regulations, State regulations, and accreditation standards.
Effective listening and critical thinking skills.
Strong interpersonal skills and high level of professionalism.
Effective problem solving skills with attention to detail.
Training/teaching skills.

Nice To Haves

Experience using the Model for Improvement (PDSA – Plan, Do, Study, Act) is preferred.
Medicaid and/or Medicare experience is preferred.
Certified Professional in Healthcare Quality (CPHQ) or American Society for Quality (ASQ) certification preferred.

Responsibilities

Conducts business process and gap analysis to diagnose process improvement opportunities and to develop re-usable solutions using principles of process excellence and related tools.
Directly responsible for improvement work teams, to include: working with management to identify the appropriate team members, coordination and facilitation of team meetings and management of improvement work team projects.
Collaborates with management team to support necessary documentation of QIPs and PIPs and other quality activities.
Trains, educates and deploys improvement tools, methods and processes throughout the departments assigned.
Analyzes work processes using improvement tools and methodology to identify improvement opportunities.
Works with management and the improvement team to establish and implement effective measurement and data collection methods.
Reviews and measures progress with management and work team and takes appropriate action.
Explores best practices across various industries to bring to the work team.
Develops, evaluates and implements survey tools.
Analyzes data from survey sources in order to provide input into improvement initiatives.
Coordinates and participates in quality improvement committee meetings; develops agendas, prepares meeting minutes, prepares and makes presentations, and follows-up on action items.
Communicates in a clear, concise, and complete manner with upper management, peers, department staff, other disciplines within the organization, outside agencies and other entities to ensure prompt and proper exchange of information and resolution of issues.
Assist with tracking, compiling and reporting program and project metrics.
Research, gather and analyze data to identify improvement opportunities.
Work closely with Maternal Child and Health Outcomes Management and Vendor Management to monitor vendor and community partner performance.
Monitor monthly/quarterly/annual reporting of vendors and ensure timely receipt and accuracy in completed material.
Participate in workgroups and applicable committees.
Prepare reports, briefing materials and other requested deliverables for programs and projects.
Perform any other job related instructions as requested.