PRINCIPAL RESPONSIBILITIES:

The Lead Quality Specialist is responsible for conducting and leading quality assessment and performance activities that include HEDIS, quality monitoring, Provider Appointment Avaliability Survey (PAAS), evaluation and facilitation of quality analytics related projects. Additionally, the Lead Quality Specialist participates and helps facilitate company-wide quality analytics initiatives.

Principal responsbilities include:

• Takes the lead on designing and the execution of Quality Analytics initiatives and projects
• Leads Year Round HEDIS initiatives and activities
• Help develop, process and manage member and provider communications as appropriate to each quality analytics
• Coordinate and participate in the collection of data from medical records, logs, databases, and error reporting systems that support quality initiatives.
• Under direction, conduct concurrent and retrospective analysis to evaluate and analyze targeted areas of performance.
• Lead and/or assist in the development and participate in process improvement initiatives, and other special initiatives.
• Comply with all regulatory and licensing agency requirements and promptly inform the applicable person(s) of changes and updates.
• Report and facilitate changes in standards of care as necessary.
• Mentors and trains the other Quality Specialists and cross departmental training for Quality Analytics initiatives.
• Perform other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB

• Prepare meeting materials, assist, facilitate, and lead internal and external meetings
• Serve as project team lead responsible for project development and execution.
• Data collection, measurement, maintenance, and analysis.
• Report and presentation development to support regulatory submissions.
• Coordinate and consult with Alliance departments on activities and projects.
• Keep abreast of healthcare industry best practices and managed care regulatory requirements.
• Comply with the organization’s Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and various other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT Work Experience:

• Bachelor’s degree or equivalent in health sciences or related field.
• Master’s degree or equivalent in health sciences or related field preferred.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• Four years of relevant healthcare experience.
• Three years of relevant project management experience preferred.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Extensive knowledge of HEDIS, PAAS, and Pay-for-Performance/Incentive programs.
• Ability to work collaboratively with physicians, staff and external organizations to improve quality outcomes.
• Strong communication and presentation skills, training/meeting facilitation skills a plus.
• Solid relationship building and interpersonal skills.
• Excellent writing, research, analytical, and time management skills.
• Excellent coordination skills, including multi-tasking and setting priorities on work assignments.
• Ability to organize and coordinate various activities involved in a research, collaborative and demonstration project.
• High degree of independence, flexibility, initiative and commitment.
• Ability to work effectively with diverse population, both internally and externally.
• Solid critical thinking and problem-solving skills.
• Ability to utilize sound judgment and promptly report potential risks.
• Ability to work in a fast paced, patient-service oriented environment.
• Demonstrate ability to promote quality improvement through development and maintenance of standards.
• Must handle PHI and maintain confidentiality at all levels.
• Proficiency in Windows including Microsoft Office suite including Word, Excel, and PowerPoint

SALARY RANGE: $92,051.06 - $138,076.59 ANNUALLY