Quality Improvement Project Coordinator

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

The Quality Improvement Department is committed to assessing current systems and processes to ensure the continuous improvement and regulatory compliance of overall health service delivery. This position is responsible for identifying, implementing, and overseeing projects relating to quality improvement/compliance initiatives in one or more of the following primary areas: •CMS Five-Star Rating System and the Quality Rating System (QRS) •Marketplace Exchange Quality Rating Systems (QRS) •NCQA Accreditation and state regulatory compliance •HEDIS

ESSENTIAL RESPONSIBILITIES

• Thoroughly reviews data, trends, and best practices to identify projects and approaches toward achieving excellence in area(s) of focus, including regulatory compliance, a 4 to 5 Star Rating in the CMS STAR Rating System, a 4 to 5 star rating in the QRS Rating System, and compliance with NCQA Accreditation standards and guidelines.
• Leads focused workgroups to identify areas of improvement, develop and implement QI strategies, and ensure compliance with regulatory/accreditation bodies. Tracks progress and coordinates recommendations from workgroup members. Reports progress and workgroup recommendations to leadership and appropriate committees, and progress on initiatives to the Quality Management Committee.
• Interfaces and coordinates efforts with various departments/vendors/contracted partners to develop and implement strategies that will address overall quality improvement, ensure compliance with regulatory requirements (NCQA, HEDIS, CMS, DOH, QRS), and align with corporate priorities.
• May serve as primary contact for the organization with regulatory bodies as it relates to reporting requirements and quality management/improvement/assurance.
• Participates in BlueCross and BlueShield Association Quality workgroups.
• Coordination of annual review of corporate administrative policies and procedures related to quality, accreditation and regulatory compliance.
• Manages projects and initiatives within the area of Health Care Quality Improvement & Reporting as needed.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years of healthcare-related work experience
• 3 years of experience managing projects

Preferred

• 3 years of experience in accreditation and regulation
  

SKILLS

• Knowledge of care management, managed care, health insurance industry, and the provider community. For Accreditation & Regulatory focus, thorough knowledge of DOH and CMS regulations and the reporting requirement components.
• Excellent verbal and written communication skills
• Ability to work effectively and manage multiple projects with minimal supervision
• High degree of business maturity and demonstrated confidentiality
• Strong organizational and leadership skills with the ability to manage multiple conflicting priorities
• Demonstrated personal accountability
• Excels in a team environment
• Project management or process improvement experience
• MS Word, Excel, PowerPoint
• Strong presentation skills
• Knowledge of Medicare processes/systems is a plus

EDUCATION

Required

• Bachelor’s degree in business administration or healthcare administration or relevant experience and/or education as determined by the company in lieu of bachelor's degree.

Preferred

• Masters degree in business administration or healthcare administration

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by