Quality Performance Specialist Senior - Clinical
Posted on: November 18, 2021
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
- Uses data and analysis tools to identify opportunities for
improved performance and collaborates with peers to develop
- Removes barriers to achieve successful completion of strategic
- Conducts analysis and provides summary reports and analysis to
- 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
- 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
- Experience working with medicaid/Medicare populations
- Knowledge and understanding of QI functions in an MCO
- Prior experience with project facilitation/management
- Excellent written and verbal communication skills.
- Excellent organizational, analytical and interpersonal
- 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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