Become a part of our caring community and help us put health first
 

The Quality Improvement Professional partners and or aligns with Stars leadership to identify and set quality goals to maximize quality outcomes. They must be comfortable functioning within a team setting especially as it relates to organizational guidelines, defined parameters, and meeting quality targets while on the other hand having some latitude to prioritize efforts, having the ability to work under minimal direction/independently.

Responsibilities

• Incumbent will have an interest and practical experience working with clinical quality measures in particular medication adherence and HEDIS. 

• Utilize approved avenues to outreach to patients with medication reminders

• Medical record review, retrieval, and submissions to health plans to support HEDIS gap closure.

• Distribute time-sensitive and actionable data to promote action on the part of clinical teams and operations to address opportunities and close gaps (excel moderate -to- advanced skills)

• Review and assess provider/member detail HEDIS data/gap reports to identify opportunities for improvement and gap closure. 

• Using critical thinking skills, QIP 1 leads efforts to identify opportunities for improvement, workflow deficiencies and barriers. 

• Provides support to provider/practice specific needs thus assisting in driving the effective implementation of the quality improvement strategy.

• Manage workloads, having the ability to meet time-sensitive deadlines such as the distribution of medication adherence reports to PCP.

• Train/educate teams on CMS Star measures, one-on-one or in a setting with multiple team members (clinicians, medical assistants, practice administrators, front office). 

• The Incumbent must have excellent interpersonal skills as well as the ability to develop working relationships and partnerships. Must be a “people person” since the role requires seamless teamwork to achieve targets/meet goals. 

•  Present STARs performance information during meetings one-on-one or in wider settings. Create PowerPoint presentation.

• Collaborates with various stakeholders/partners (internal and external) including market operations/provider relations, coding teams; medical directors, clinical and health plan teams, and vendors to provide support and in some cases assist with the execution of workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.

• Support quality initiatives eye screenings, bone mineral density, mobile mammogram etc. 

• This role would be responsible for supporting both staffed and IPA clinics- Staffed CenterWell Clinics 70% of time and IPA clinics in the Tidewater/Peninsula VA area 30% of the time.

**Incumbent must be located in Virginia

Use your skills to make an impact
 

Required Qualifications:

• Understanding of healthcare quality measures STARS (HEDIS, Patient Experience (CAHPS/HOS) and Patient Experience in particular knowledge of the measure technical specifications etc.

• Minimum of 2 years' experience working with CMS STARs quality measures.

• Prior experience in a fast-paced health care setting direct hands-on patient care, front office or provider relations field.

• Experienced providing training 1:1 or in a group setting.

• Ability to work independently but within team guidelines and standardized workflow.

• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint and excellent communication and presentation skills

Preferred Qualifications:

• Bachelor’s or Associate Degree

• Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.

• Knowledge of Humana's internal policies, procedures, and systems.

Additional Information:

• Work schedule: M-F, 8AM-5PM. Occasional after 5PM meeting.

• Work-at-home and visits to various medical centers and or IPA offices on a quarterly basis

• Occasional Travel to Tidewater/Peninsula VA area to CenterWell and IPA clinics Mileage. Reimbursement will be provided.

• Must be located in Virginia

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time