Stars Quality Improvement Professional

CenterWell • Austin, TX

2d • $59,100 - $79,900 • Remote

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. You will 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). Your 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 report to the Associate Director, Quality Improvement.
You will use 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 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.
Lead efforts to identify opportunities for improvement, workflow deficiencies and barriers.
Develop and implement strategies to achieve annual Stars goals within market and centers.
Provide support to provider/practice specific needs thus helping guide the 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 presentations.
Collaborate with multiple partners to provide support and in some cases help implement workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.
Support quality project events such as eye screenings, bone mineral density, etc.

Requirements

• Experience with 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 healthcare setting direct hands-on patient care, front office or provider relations field.
• Experienced providing training 1:1 or in a group setting.
• Experience with Microsoft Office Suite.
• Must reside in the Houston area and be willing to travel locally.

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

• Use 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 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.
• Lead efforts to identify opportunities for improvement, workflow deficiencies and barriers.
• Develop and implement strategies to achieve annual Stars goals within market and centers.
• Provide support to provider/practice specific needs thus helping guide the 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 presentations.
• Collaborate with multiple partners to provide support and in some cases help implement workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.
• Support quality project 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree