$82658 - $91600 Year
Monday to Friday
Day shift
Health insurance
Paid time off
Employee discount
Dental insurance
Vision insurance
401(k)
401(k) matching
Flexible schedule
Parental Leave
Tuition reimbursement
Flexible spending account
Retirement plan
The Sr CQC will participate in quality improvement initiatives, attend monthly or joint operating committee meetings, develop recommendations for quality remediation plans and create tools and databases to capture relevant data for each region. This position will work collaboratively with each regional/market team and their leadership in a matrix relationship. This position may serve as the team lead for the clinical quality consultants in the assigned market and has responsibility for the network’s quality performance.
Primary Responsibilities:
Develop market business plans to motivate providers and large or complex group leadership to engage in improving Stars measures to be 4 STARS or higher
Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
Be the primary subject matter expert for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
Lead or participate and present in weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider and large group performance and market performance as requested by or required by Quality or Regional leadership
Analyze and evaluate provider and large group structure and characteristics, provider group/provider office operations and personnel to identify the most effective approaches and strategies
Assist in developing of training and analytical materials for Stars and HEDIS
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Years of post-high school education can be substituted/is equivalent to one year of experience.
Required Qualifications:
Registered Nurse (within the states in which service is being delivered). In lieu of RN, Licensed Practice Nurse (LPN) with 5+ years of experience in HEDIS/STAR programs acceptable
4+ years of healthcare experience, including experience in a managed care setting
2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role
2+ years of experience in provider facing interactions, including provider education
2+ years of experience with data analysis and/or quality chart reviews. Must be able to review data and provide recommendations for improvement
Proficient in Excel
50% local travel with occasional overnight travel
Preferred Qualifications:
Billing and CPT coding experience
Clinical data abstraction experience
Experience using Microsoft office applications, including databases, word-processing, and excel spreadsheets
Medicare experience
Physical & Mental Requirements:
Ability to lift up to 10 pounds
Ability to push or pull heavy objects using up to pounds of force Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery Ability to properly drive and operate a vehicle
Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving
Communication
Leadership
Teamwork
Interpersonal
Learning/adaptability
Self-management
Organizational
Computer
Problem solving
Open mindedness
Strong work ethic
technology
4+ years of healthcare experience including experience in a managed care setting
2+ years of experience in HEDIS/Star programs preferably in a clinical quality consultant role
2+ years of experience in provider facing interactions including provider education
2+ years of experience with data analysis and/or quality chart reviews
Registered Nurse with 5+ years of experience in HEDIS/STAR programs acceptable
Health care
3
Remote