Quality Improvement Project Coordinator; Remote

Company: Highmark Inc.

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.

Job Summary:

• 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.

Required

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

Preferred

• 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

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

Required

• None

Preferred

• 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

Disclaimer:
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 required of employees to do this job.

Compliance Requirement:
This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component…