Network Hospital Quality Coordinator

Blue Cross & Blue Shield of Mississippi•Flowood, MS

59d•Hybrid

About The Position

At Blue Cross & Blue Shield of Mississippi, we are seeking a Network Hospital Quality Coordinator to drive data-driven decision-making which enhances the quality of care provided by Network Hospitals and Providers using the Comprehensive Quality Model and align with regulatory, accreditation and safety standards. This Quality Coordinator acts in partnership with Hospitals and Providers to develop and implement improvement plans based on evidence-based best practices and value-based initiatives.

Requirements

Bachelor’s degree in a business-related field, or clinical designation, such as R.N.
Five years of healthcare administration and/or clinical experience.
Experience analyzing and trending healthcare related data.
Experience in the development and implementation of provider/hospital quality improvement programs and activities intending to monitor/improve health related outcomes.
Proficiency using Microsoft Word and Excel.
Ability to work when required, on a flexible schedule and with moderate travel.
Working knowledge and expertise of healthcare quality, particularly as it relates to providers.
Ability to analyze complex data sets to define and develop performance metrics.
Proven ability to lead projects from conception to completion.
Strong interpersonal skills to build solid business relationships and collaborate with diverse teams including medical providers, frontline staff and those from other Blue Plans or Blue Cross Blue Shield Association.
Work with a high degree of accuracy.
Ability to manage and maintain confidentiality of information.
Strong verbal communication skills to facilitate multidisciplinary meetings and drive continuous improvement and improve patient care while maintaining the capacity to build consensus effectively.
Written communication skills to ensure that documentations and reports are accurate, detailed and clear, using proper medical terminology to prevent life-threatening misinterpretations.

Nice To Haves

Master’s degree in healthcare administration or nursing.
Experience with Microsoft Access and Visio.
Knowledge of accreditation programs such as The Joint Commission, Det Norske Veritas (DNV) and National Committee for Quality Assurance (NCQA).
Knowledge of value-based programs such as Bundled Payments for Care Improvement (BPCI) and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Knowledge of Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases, Tenth Revision (ICD10), Uniform Billing (UB) Revenue and National Drug Code (NDC) coding.
Knowledge of High Reliability Organizations’ quality improvement methodologies and/or certification in quality process improvement.

Responsibilities

Review data and key performance indicators (KPIs) to identify trends, benchmark against standards and pinpoint areas for improvement.
Develop, implement and monitor quality improvement projects based on evidence-based practices in alignment with the Comprehensive Quality Model (CQM) and other value-based initiatives.
Ensure adherence to federal and state regulations, as well as standards from organizations such as Centers for Medicare & Medicaid Services(CMS) and The Joint Commission.
Conducts audit projects and develops corrective action plans for identified gaps.
Research methods and best practices for clinical care, recommending updates to existing measures to align clinical best practice research and reimbursement programs.
Present actionable data to improve performance, build trust and enhance public brand.