Quality Improvement Project Coordinator; Remote

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

• 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 work groups 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 Blue Cross and Blue Shield Association Quality work groups.
• 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.

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

• 3 years of experience in accreditation and regulation

• 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, Power Point
• Strong presentation skills
• Knowledge of Medicare processes/systems is a plus

• 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.

• Masters degree in business administration or healthcare administration

• None

• None

None

0% - 25%

• 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

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications…