• Quality Improvement Specialist

    Job Locations US-RI-Smithfield
    Req No.
    2019-10602
    NHPRI Department
    803 - Evaluation and Improvement
    Type
    Regular Full-Time
  • Overview

    The Quality Improvement Specialist leads and supports the collection, analysis and reporting of data and the development of intervention strategies in support of quality improvement efforts. This position leads and supports quality improvement activities across all lines of business, including the Medicaid, commercial and Medicare-Medicaid product lines. He/she supports improvement efforts targeting quality and operational measures relating to contractual requirements and pay-for-performance programs, and identifies and communicates areas where the organization is at risk of failing to meet contractual or pay-for-performance goals. This position will lead and/or support in quality improvement team(s) inclusive of members across multiple departments.

    Responsibilities

    • Maintains an in-depth knowledge of quality improvement requirements for all product lines
    • Leads the preparation and submission of reports on regulatory-required quality improvement projects
    • Leads and supports quality improvement projects for all product lines, inclusive of data collection, analysis, reporting and improvement teams
    • Leads and supports identification and implementation of quality improvement activities across the organization targeting priority measures
    • Monitors and collaborates with stakeholders to identify improvement strategies for pay-for-performance quality measures
    • Identifies and communicates risk areas and barriers that could inhibit the organization’s ability to achieve the highest pay-for-performance incentives for all product lines
    • Develops and implements comprehensive plans for assigned responsibilities including delineated tasks, resource requirements, and timelines and milestones, using appropriate tools
    • Develops written reports inclusive of qualitative and quantitative analysis outlining conclusions and recommendations for improvement
    • Participates in developing core quality improvement documents for the organization
    • Develops and applies expertise in utilizing internal and external data sources and benchmarks to meet the analytic challenges posed by quality improvement cycles
    • Other duties as assigned
    • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.

    Qualifications

    Required:

    • Bachelor’s degree in Business or Health-related field or sufficient work experience to equate to a degree
    • Three (3)+ years’ experience working in healthcare
    • Experience working with quality improvement methods and strategies, health care analytics, regulatory requirements and project management
    • Experience working with statistical analysis of complex health care data sets, including health care claims, health surveys and health outcomes data, to support improvement activities
    • Strong analytical, attention to detail and critical thinking skills
    • Demonstrated ability to develop and implement detailed project plans, including managing multiple projects simultaneously in a deadline driven environment
    • Excellent interpersonal skills, including the ability to work across the organization and to interact, influence and negotiate effectively at all levels of management
    • Confident team builder and leader with strong motivational and problem solving skills
    • Effective communication skills, both verbal and written
    • Outstanding time management and organizational skills
    • Proficient in Microsoft Excel, PowerPoint and Word

    Preferred:

    • Three (3)+ years’ experience working in a managed care environment with focus on quality improvement, health care analytics and quality improvement requirements
    • Experience in demonstrating leadership, influence and collaboration in a matrix-managed environment
    • Two (2)+ years’ experience in the analysis and interpretation of health care data, such as health care claims data, public health surveillance data, health survey data and clinical data abstracted from medical records
    • Knowledge of medical coding systems used for diagnoses, procedures, pharmaceuticals and clinical laboratory data

    Organizational Competencies:

    • Judgment and Decision Making
    • Gets Results
    • Collaboration and Teamwork
    • Business Awareness
    • Customer Focus

    Job Specific Competencies:

    • Flexibility & Achieving Change
    • Relationship Building & Networking
    • Continuous Quality Improvement
    • Planning & Organizing
    • Problem Solving & Analysis

    Travel Expectations:

    • Some travel locally between locations is required

     

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

     

    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org.

     

    Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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