Stars - Quality Improvement Professional
About The Position
The Stars Quality Improvement Professional will support clinicians and staff, working collaboratively with the staffed clinical and operations teams including center administrators. Provide support, make recommendations and help implement quality improvement best practice programs designed to improve CMS Star measures (HEDIS), patient safety and patient experience (CAHPS-HOS). Quality Improvement Professional assignment may be coverage of PCO staffed providers and PCO Independent Network provider/practices functioning in a similar capacity as described previously for support to the staffed centers. Best suited candidate will have an interest and practical experience working with clinical Star measures in particular medication adherence and HEDIS. You will need to work in and around our Las Vegas clinics 4 out of 5 days.
Requirements
- Strong understanding of healthcare STARS measures (HEDIS, Patient Safety, and Patient Experience (CAHPS/HOS) in particular knowledge of the measure technical specifications.
- 2 + years' experience working with CMS Stars measures.
- Prior experience in a health care setting direct hands-on patient care, front office or provider relations field.
- Experienced providing training 1:1 or in a group setting.
- Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint and excellent communication and presentation skills
- Must be willing to travel locally, to our CenterWell Nevada market.
- Must reside in Las Vegas area
Nice To Haves
- Bachelor's Degree
- Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.
- Knowledge of Humana's internal policies, procedures, and systems.
Responsibilities
- Utilize approved avenues to outreach to patients with medication reminders
- Medical record review, retrieval, and submissions to health plans to support HEDIS gap closure.
- Distribute time-sensitive and relevant data to promote action on the part of clinical teams and operations to address opportunities and close gaps (excel moderate -to- advanced skills)
- Review and assess provider/member detail HEDIS data/gap reports to identify opportunities for improvement and gap closure.
- Leads efforts to identify opportunities for improvement, workflow deficiencies and barriers.
- Develop and implement strategic action plans to achieve annual Stars goals within market and/or centers
- Provides support to provider/practice specific needs thus assisting in driving the effective implementation of the quality improvement strategy.
- Manage workloads such as the distribution of medication adherence reports to PCP.
- Train/educate teams on CMS Star measures, one-on-one or in a setting with multiple team members (clinicians, medical assistants, practice administrators, front office).
- Present Stars performance information during meetings one-on-one or in wider settings. Create PowerPoint presentation.
- Collaborates with various stakeholders/partners (internal and external) including market operations/provider relations, coding teams; medical directors, clinical and health plan teams, and vendors to provide support and in some cases assist with the execution of workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.
- Support quality initiatives events such as eye screenings, bone mineral density, etc.
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
