Job Information
AmeriHealth Caritas Quality Performance Specialist in United States
Job Summary
As part of the Quality Management team, the Quality Performance Specialist is responsible for the coordination and ongoing monitoring of QI program objectives, including performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and supporting HEDIS, CAHPS and URAC and NCQA accreditation activities. Supports the overall implementation of quality programs that meet or exceed applicable State, Federal, and URAC and NCQA standards.
Principal Accountabilities:
Executes on organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting bodies’ standard requirements
Analyzes annual HEDIS results and works with all areas to integrate results into departmental goals.
Responsible for the successful development and evaluation of an annual QI work plan and program description by facilitating QI throughout the organization.
Identifies, resolves, or escalates problematic QI areas that may place department or plan at risk of not achieving annual goals.
Collaborates with Provider Services and Member Services to complete analysis of annual satisfaction surveys and works with all areas to integrate results into departmental goals.
Participates in the development, implementation and maintenance of QI policies and procedures.
Serves as a resource to other departments in completing QI goals.
Works professionally and efficiently with all functional areas in meeting organizational and departmental quality goals.
Participates on QI committees structured to achieve outcomes and success; and completes committee documentation that is consistent in meeting regulatory and accrediting body requirements.
Education/Experience:
Bachelor’s Degree required
Master's Degree preferred
Minimum of 3 years in clinical or service quality improvement required.
Minimum of 3 years in healthcare delivery required.
Certifications:
- CPHQ preferred
Other Skills:
Managed Healthcare experience preferred.
Successful management of NCQA accreditation survey preferred.
Excellent organizational, analytical and interpersonal skills.
Excellent written and verbal communication skills.
Ability to 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.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
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 Newtown Square, 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 .
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.