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

The Quality Improvement Professional implements quality improvement programs for all lines of business including annual program description, work plan, and annual evaluation. The Quality Improvement Professional work assignments are often straightforward and of moderate complexity.

The Quality Improvement Professional (QIP) partners and or aligns with Stars leadership to identify and set quality goals to maximize quality outcomes. 

He/she 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. 

The QIP 1 will support clinicians and staff, working collaboratively with the market’s Stars Clinical Quality RN/s, to support staffed clinical and operations teams including center administrators. Provide support, make recommendations and assist with implementing quality improvement best practice initiatives designed to improve Medicare quality measures (HEDIS), patient safety and patient experience (CAHPS-HOS). QIP assignment may be coverage of Conviva PCO staffed providers and or PCO Independent Network provider/practices functioning in a similar capacity as described previously for support to the staffed centers. Using critical thinking skills, QIP 1 leads efforts to identify opportunities for improvement, workflow deficiencies and barriers.

Job Functions

• Works collaboratively with employed physicians and independent providers within the Conviva network and their teams to provide support, guidance, make quality improvement recommendations and assist with implementation of practice specific strategies designed to improve Medicare quality measures (HEDIS), patient safety and patient experience (CAHPS-HOS).

• Assists with the formulation of quality objectives to maximize quality outcomes.

• 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.

• 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.

• Responsible for training.

• Reviews and assesses provider/member detail HEDIS data/gap reports to identify opportunities for gap closure.

• Applies critical thinking to prioritize PCP outreach.

• Distributes time-sensitive and actionable data to promote action on the part of clinical teams and operations to address opportunities and close gaps.

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

**Incumbent must reside in FL

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

Preferred Qualifications

• Bachelor's degree

• Bilingual preferred (English & Spanish)

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

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

Additional Information

• 100% Remote role

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

• Minimal travel (~10% annual) visits to various medical center