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Quality Performance Specialist Senior - Clinical

Company: Amerihealth
Location: Charleston
Posted on: November 18, 2021

Job Description:

Job BriefGreat oppo4rtuioty for an experienced healthcare Quality Performance Management RN. Medicare/Medicaid experience a plus.Your career starts now. We're looking for the next generation of health care leaders.At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.Responsibilities:The Senior Quality Performance Specialist - Clinical is responsible for taking on responsibilities that support the day-to-day operations.and implementation of Quality projects ensuring identification of root cause, and with the assistance of the Quality Director establishes a work plan to implement interventions This position will work in a collaborative manner with all providers, members, departments within AmeriHealth Caritas to conduct ongoing process and data review to identify opportunities for improvement. The position will manage the plan's accreditation, preventive health improvement, business analysis and clinical/service quality improvement (including State Withholds, HEDIS and CAHPS). In addition to established a quality improvement philosophy throughout the organization and promotes the use of QI tools in decision-making.This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care standards aimed at improving Service and Clinical Operation performance by:

  • Develops reports and analysis for semi-annual trending reports and presents to the Quality Committee) for input and direction In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and, Clinical Practice Guidelines. The position also supports accreditation and clinical quality performance improvement activities.
  • Performs ad-hoc analysis of any underperforming or "broken" processes by collaborating with Subject Matter Experts and/or Customers to define existing processes and make recommendations for improvement.
  • Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies.
  • Removes barriers to achieve successful completion of strategic projects.
  • Conducts analysis and provides summary reports and analysis to senior management.
  • Acts as a primary liaison and contact to internal departments that require collaboration and coordination.
  • Supports the development of new and existing staff by identifying learning / training opportunities.
  • Acts as mentor for all new hire positions in order to ensure uniformity of information/training.Education/Experience:
    • Associate's Degree or equivalent education and work experience.
    • Registered Nurse with a Clear/Active license in the state of South Carolina, or multiple state Compact RN license required.
    • Minimum of 5 years in clinical or healthcare service quality improvement required.
    • Experience working with medicaid/Medicare populations preferred.
    • Knowledge and understanding of QI functions in an MCO preferred.
    • Prior experience with project facilitation/management preferred.
    • Excellent written and verbal communication skills.
    • Excellent organizational, analytical and interpersonal skills.
    • Ability to communicate and work successfully within all levels of the organization.
    • Ability to design, develop and implement projects to address financial, quality and service improvements.
    • Proficient PC skills in a windows based environment.
    • Successful experience managing NCQA accreditation survey preferred.Back ShareApply Now

Keywords: Amerihealth, Charleston , Quality Performance Specialist Senior - Clinical, Healthcare , Charleston, South Carolina

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