- Qualitative and Quantitative Analysis of key Quality and Health Plan Initiatives
- Collaborate and assisting with education to providers, office staff and internal stakeholders to increase engagement on all health plan performance initiatives that support regulatory requirements for programs such as HEDIS, NCQA, CAHPS, and Star Ratings.
- Ability to maintain effective working relationships with internal staff, physicians, other providers, staff, employers, regulatory agencies, and enrollees.
- Focus on closing care gap opportunities that support the health plan performance initiatives.
- Simultaneous action at varying stages-initiation, follow through, and completion-on a number of different projects.
- Resourceful, detail-oriented, and able to assimilate and analyze a wide variety of information, often working under deadline pressure with a variety of levels of staff.
- Ability to review, analyze and interpret regulatory requirements in a clear and concise manner.
- Implements surveillance activities to ensure all quality and regulatory standards are being met.
- Analyzes data collected and makes recommendations for process improvements.
- Assists in the education of new policies and procedures designed to enhance quality care and minimize patient, visitor, and employee risk.
- Provide comprehensive project management for quality improvement and regulatory initiatives.
- Demonstrate the ability to design and develop reports, documents and spreadsheets.
- Excellent organization and problem-solving skills as well as qualitative and quantitative analytical skills.
- Ability to work independently with minimal supervision.
- Coordination and management of Health Plan Quality Improvement Committees
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NCQA Accreditation Analyst - Reno, United States - Renown Health
Description
Position PurposeThis position assists the Quality department in coordinating, developing, implementing and maintaining the quality improvement programs for Hometown Health. Based on the direction of the Leadership team this position will also capture, analyze and report data regarding the effectiveness of the Hometown Health Quality programs and operational performance in relation to quality initiatives. If needed based on the analysis, this position is responsible for conducting a root cause analysis and developing and implementing procedures for improved performance and continued follow-up. Additionally, this position will participate in the development of policies and procedures, standard work and educational materials for staff, members and network providers to support quality initiatives across Hometown Health and focus on increased performance based on data surrounding HEDIS, CMS Star measures, quality improvement initiatives, and proper medical record documentation.
The Quality Analyst will support the Quality Program to ensure compliance with all Federal and State laws and regulations (CMS, Nevada DOI), regulatory programs (HEDIS, Stars), accreditation standards (NCQA), and member experience (CAHPS). The Analyst will implement system wide initiatives, policies and processes related to the Quality Program and be responsible for program oversight, risk assessment, report management, data analysis, communication strategy, and education/training and auditing/monitoring. This position may specialize in key quality programs but will collaborate across all programs and with other departments.
This position will be primarily responsible for the administrative functions of the Quality Committees to include the development of the agenda, gathering of required reporting and documentation and taking minutes to ensure that the content of the meeting is accurately reflected. The position will also be responsible for maintaining the quality calendar to ensure that all required reporting and regulatory and accreditation deadlines are met.
Nature and Scope
The position will involve a significant amount of regulatory and accreditation research as well as technical specification review to accurately educate and support key stakeholders in each quality program. The position will utilize new technology, as appropriate, for efficient delivery of services and to make informed decisions based on data, to drive performance metrics across all health plan performance initiatives.
The position will provide support with managing the development, implementation, compliance and oversight of Hometown Health's Quality Improvement Programs. Components of this position include NCQA Accreditation, Risk Adjustment, Stars, HEDIS, and Member Satisfaction. This position will perform other duties as requested.
The essential functions of the position are:
This position does not provide patient care.
Disclaimer
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
Name
Description
Education:
Must have working-level knowledge of the English language, including reading, writing, and speaking English. Bachelor's degree in public health, Business, Health Care Administration or health-related discipline preferred.
Experience:
Minimum of three years of healthcare experience required.
Experience working in a Medicare Advantage plan, specific to NCQA Accreditation, HEDIS, CAHPS, and Stars ratings is strongly preferred.
Project Management and data analysis experience preferred.
License(s):
None
Certification(s):
None
Computer / Typing:
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
