Quality Improvement Specialist- Health Plan

Parkland Health & Hospital System•Dallas, TX

56d•Hybrid

About The Position

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Primary Purpose Responsible for managing Performance Improvement Projects from inception to completion, ensuring our healthcare services consistently meet the highest standards of quality and efficiency. The role will analyze current practices, identify areas for improvement, and implement strategies to enhance member care, member outcomes and operational efficiency.

Requirements

Bachelor's degree in business administration or related discipline is required.
Minimum of 3-5 years of experience in healthcare quality improvement is required.
Experience with Texas Medicaid, Medicaid, or managed care quality improvement strongly preferred.
May have an equivalent combination of education and/or experience in lieu of specific education and/or experience.
Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms.
Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization.
Excellent analytical and problem-solving skills.
Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
Ability to write clearly and succinctly with a high level of attention to detail.
Proficient computer and Microsoft Office skills. Ability to learn new software programs.
Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
Proficiency in data analysis software and tools.
Strong project management skills.
Ability to work independently and take initiative.

Nice To Haves

Bachelor's degree in the healthcare field preferred.
Certification in Six Sigma, Lean, or other quality improvement methodologies preferred.
Clinical experience is a plus

Responsibilities

Develop and implement quality improvement initiatives.
Use quality improvement tools and techniques such as Six Sigma, Lean, and PDSA cycles.
Lead end-to-end management of PIPs, from conception through planning, execution, monitoring, and closing, ensuring all milestones are met and documented.
Ensure member and staff feedback is incorporated into quality improvement efforts.
Integrate health literacy principles into all communication including Members and Providers.
Support strategies that meet clinical, quality and network improvement goals.
Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed.
For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination.
Prepares reports for HHSC according to HHSC requirements and timelines
Coordinate with external agencies when required by the project
Tracks and monitors all interventions implemented and evaluates the impact of each intervention utilizing data driven methodologies,
Makes adjustments to interventions as required per performance indicators
Supports quality leaders develop quality plans and ensure integration of quality into overall business processes.
Develops performance improvement plans and oversees quality improvement activities to improve the quality of care for members.
Develop plans to improve HEDIS scores and other quality metrics prepare and present them to management and Providers.
Analyze current healthcare practices and identify areas for improvement, and present findings and recommendations to senior management and other stakeholders.
Monitor and evaluate the effectiveness of quality improvement initiatives.
Collect and analyze data to measure performance and outcomes.
Prepare reports and documentation for internal and external use.
Conduct root cause analysis for adverse events.
Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements.
Coordinate with external agencies and accrediting bodies.
Assures compliance with Quality Improvement work plans and assures QI activities are relevant to targeted populations.
Promotes and supports a culturally welcoming and inclusive work environment.
Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
Adheres to organizational policies, procedures, and guidelines.
Completes assigned training, self-appraisal, and annual health requirements timely.
Adheres to hybrid work schedule requirements.
Attends required meetings and town halls.
Recognizes and communicates ethical and legal concerns through the established channels of communication.
Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
Maintains confidentiality at all times.
Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.
Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP.
Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.