Market Quality Improvement Specialist III

Job Summary:

The Market Quality Improvement Specialist III collaborates with department manager and other leadership to evaluate opportunity for HEDIS data and process improvement in new or existing projects with focus on measurable benefits.

Essential Functions:

• Conducts business process and gap analysis to diagnose process improvement opportunities and to develop re-usable solutions using principles of process excellence and related tools
• Directly responsible for improvement work teams, to include: working with management to identify the appropriate team members, coordination and facilitation of team meetings and management of improvement work team projects
• Collaborates with management team to support necessary documentation of QIPs and PIPs and other quality activities
• Trains, educates and deploys improvement tools, methods and processes throughout the departments assigned
• Analyzes work processes using improvement tools and methodology to identify improvement opportunities
• Prepare and make presentations to Providers without supervision, strengthens relationships and answers questions that arise
• Works with management to establish and implement effective measurement and data collection methods
• Reviews and measures progress with management and work team and takes appropriate action
• Explores best practices across various industries to bring to the work team
• Develops, evaluates and implements survey tools
• Analyzes data from survey sources in order to provide input into improvement initiatives
• Coordinates and participates in quality improvement committee meetings; develops agendas, prepares meeting minutes, prepares and makes presentations, and follows-up on action items
• Communicates in a clear, concise, and complete manner with upper management, peers, department staff, other disciplines within the organization, outside agencies and other entities to ensure prompt and proper exchange of information and resolution of issues
• Assist with tracking, compiling and reporting program and project metrics
• Research, gather and analyze data to identify improvement opportunities
• Work closely with Maternal Child and Health Outcomes Management and Vendor Management to monitor vendor and community partner performance
• Monitor monthly/quarterly/annual reporting of vendors and ensure timely receipt and accuracy in completed material
• Participate in workgroups and applicable committees
• Prepare reports, briefing materials and other requested deliverables for programs and projects
• Perform any other job related instructions as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is required
• Minimum of five (5) years of healthcare or managed care experience is required
• Experience using the Model for Improvement (PDSA – Plan, Do, Study, Act) is preferred
• Medicaid and/or Medicare experience is preferred

Competencies, Knowledge and Skills:

• Knowledge of a variety of quality improvement methodologies – Model for Improvement, Lean, Six Sigma
• Knowledgeable of HEDIS measures and specifications
• Proficient in leading teams through establishing aim statements and identifying small tests of change
• Proficient in establishing and documenting PDSA cycles and key driver diagrams
• Excellent team facilitation skills
• Ability to engage teams in a positive, energetic manner
• Ability to work in a provider facing role
• Research, data analysis and trending
• Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
• Excellent written and verbal communication skills
• Ability to develop, prioritize and accomplish goals
• Ability to work independently and within a team environment
• Attention to detail
• Familiarity of the health care field
• Familiarity with applicable Federal regulations, State regulations, and accreditation standards
• Effective  listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem solving skills with attention to detail
• Training/teaching skills

Licensure and Certification:

• Certified Professional in Healthcare Quality (CPHQ) or American Society for Quality (ASQ) certification preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business