Market Quality Improvement Specialist III

CareSource • Dayton, OH

2d • Onsite

About The Position

The Market Quality Improvement Specialist III collaborates with department manager and other leadership to evaluate opportunity for HEDIS data and process improvement in new or existing projects with focus on measurable benefits. The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Requirements

• Bachelor’s degree or equivalent years of relevant work experience is required
• Minimum of five (5) years of healthcare or managed care experience is required
• Knowledge of a variety of quality improvement methodologies – Model for Improvement, Lean, Six Sigma
• Knowledgeable of HEDIS measures and specifications
• 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
• Ability to work in a provider facing role
• 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
• Prepare and make presentations to Providers without supervision, strengthens relationships and answers questions that arise
• Works with management 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

Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior