Vacancy expired!
Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Responsibilities: As part of the Quality Management team, the Senior Quality Performance Specialist - Senior is responsible for the oversight, design, and implementation of Quality projects ensuring identification of root cause, and with the assistance of the Quality Director establishes a work plan to implement interventions This position will work in a collaborative manner with all providers, members, departments within AmeriHealth Caritas to conduct ongoing process and data review to identify opportunities for improvement. This position is responsible for leading and coordinating the clinical quality review process of member concerns and medical records utilizing of care standards aimed at improving Service and Clinical Operation performance by:- Develops reports and analysis for semi-annual trending reports and presents to the Quality Committee) for input and direction In addition, responsibilities also include supporting the annual medical record review activities including HEDIS and, Clinical Practice Guidelines. The position also supports accreditation and clinical quality performance improvement activities.
- Performs ad-hoc analysis of any underperforming or "broken" processes by collaborating with Subject Matter Experts and/or Customers to define existing processes and make recommendations for improvement.
- Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies.
- Removes barriers to achieve successful completion of strategic projects.
- Conducts analysis and provides summary reports and analysis to senior management
- Acts as a primary liaison and contact to internal departments that require collaboration and coordination.
- Supports the development of new and existing staff by identifying learning / training opportunities.
- Acts as mentor for all new hire positions in order to ensure uniformity of information/training.
- Associate's Degree or equivalent work experience.
- Registered Nurse required.
- Minimum of 5 years in clinical or service quality improvement required.
- Minimum of 5 years in healthcare quality required.
- An unrestricted registered nurse license in the plan's state or any other state he/she works.
- Successful management of NCQA accreditation survey preferred.
- Knowledge and understanding of QI functions in an MCO preferred.
- Prior experience with project facilitation/management preferred.
- Excellent written and verbal communication skills.
- Excellent organizational, analytical and interpersonal skills.
- Ability to work successfully within all levels of the organization.
- Ability to design, develop and implement projects to address financial, quality and service improvements.
- Proficient PC skills in a windows based environment.
Vacancy expired!