Medicare Clinical Quality Consultant

MEDICARE CLINICAL QUALITY CONSULTANT (RN PREFERRED) (HEALTHCARE)

Work from home (telecommute) within Oregon, Washington, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s Medicare Quality Team is living our mission to make health care easier and lives better. The Quality Consultant Senior develops and implements quality improvement programs related to clinical quality measurement and outcomes and assists in resolving deficiencies that impact plan compliance to regulatory accreditation standards and/or quality measurement.  Ensures activities meet regulatory requirements of the state or product and reflects Cambia’s quality strategies, approaches and work plans – all in service of making our members’ health journeys easier.  

If you're a motivated and experienced People Leader with Medicare experience looking to make a difference in the healthcare industry, apply for this exciting opportunity today!
 

What You Bring to Cambia: 

Preferred Key Experience:

• Clinical Experience (RN/BSN)

• Medicare STARS

• HEDIS

Qualifications and Certifications:  

• Bachelor’s degree in business administration or related field

• 8 years of progressive experience in health care administration, quality, project leader or project support

• Equivalent combination of education and experience

Skills and Attributes (Not limited to):  

• Knowledge of quality improvement processes and performance measurement and ability to develop and accomplish clinical quality measurement and/or program activities.

• Demonstrated ability to identify problems, develop solutions and implement a chosen course of action.

• Leadership skills with the ability to direct activities of others both individually and within a project team .

• Ability to organize, plan, prioritize and develop multiple projects within time constraints.

• Strong knowledge and understanding of data integrity/validity standards and significance.

• Ability to perform sound basic quantitative and qualitative analyses and interpretation.

• Knowledge of the healthcare industry, preferably in the managed care market.

• Excellent verbal and written communication skills including ability to communicate effectively across multiple areas and levels.

• Participation in successful NCQA/URAC accreditation process, AND/OR  full HEDIS production reporting and continuous process improvement experience preferred. 

• Previous participation in successful completion of the NCQA/URAC accreditation process and continuous process improvement experience in an NCQA/URAC setting.AND/OR prior responsibility for annual HEDIS production including audit and medical record collection.

What You Will Do at Cambia (Not limited to):   

• Develops and maintains required/applicable quality program documents, including a standardized quality management plan and program to ensure compliance with external regulatory and accreditation and/or performance measurement requirements.

• Serves as a point of contact, coordinating and collaborating with accreditation entities and business partners to ensure compliance with accreditation and/or performance measurement requirements. Prepares enterprise for accreditation and/or performance measurement submissions and reviews.

• Serves as the subject matter expert for applicable accreditation standards/measurement requirements. Makes recommendations to business unit partners for improvements or remediation to accreditation/reporting  compliance/improvement  programs.

• Monitors exposure to accreditation/measurement risks and identifies opportunities to manage and mitigate those risks.

• Compiles information related to quality improvement and accreditation monitoring activities for internal use and external audits and maintains relevant records.

• Assists with the development and maintenance of required quality program documents.  Responsible for reporting activities to the quality committee and management.

• Responsible for managing and coordinating quality committees, including committee scheduling, workflows, production of contemporaneous committee minutes, reporting and processes in support of the Quality Program.