Market Quality Improvement Specialist II

CareSource Management Services LLC; Dayton (OH); Hybrid; USD 63,000 - 100,000; Full time

Job summary

CareSource is seeking a Market Quality Improvement Specialist II to collaborate with leadership on evaluating HEDIS data opportunities and to drive measurable process improvements in new or existing projects. The role centers on applying quality improvement methodologies, leading teams, and delivering data-driven recommendations to enhance care and outcomes.

The specialist will conduct analyses, train staff on improvement tools, and coordinate cross-functional activities to ensure timely,

Qualifications

• Bachelor’s degree or equivalent years of relevant work experience is required
• Experience with Model for Improvement (PDSA) is preferred
• Healthcare quality improvement experience (Medicaid/Medicare) preferred

Responsibilities

• Conducts business process and gap analysis to diagnose improvement opportunities and develop reusable solutions
• Directly responsible for improvement work teams, including identifying team members and managing meetings and projects
• Collaborates with management to document QIPs and PIPs and other quality activities
• Trains, educates and deploys improvement tools and processes throughout departments
• Analyzes work processes to identify improvement opportunities using improvement methodologies
• Establishes and implements data collection methods and measurement with management
• Coordinates quality improvement committee meetings and prepares agendas and minutes
• Communicates clearly with executives, staff, and external partners to resolve issues
• Tracks and reports program and project metrics
• Researches data to identify improvement opportunities and shares findings with teams

Skills

Quality improvement

PDSA cycles

Lean Six Sigma

Team facilitation

Data analysis

Communication

Education

Bachelor’s degree or equivalent years of relevant work experience

Tools

Microsoft Office Suite

Job description

Job Summary:

The Market Quality Improvement Specialist II collaborates with department manager and other leadership to evaluate opportunity for HEDIS data and process improvement in new or existing projects with focus on measurable benefits.

Essential Functions:

• Conducts business process and gap analysis to diagnose process improvement opportunities and to develop re-usable solutions using principles of process excellence and related tools
• Directly responsible for improvement work teams, to include: working with management to identify the appropriate team members, coordination and facilitation of team meetings and management of improvement work team projects
• Collaborates with management team to support necessary documentation of QIPs and PIPs and other quality activities
• Trains, educates and deploys improvement tools, methods and processes throughout the departments assigned
• Analyzes work processes using improvement tools and methodology to identify improvement opportunities
• Works with management and the improvement team to establish and implement effective measurement and data collection methods
• Reviews and measures progress with management and work team and takes appropriate action
• Explores best practices across various industries to bring to the work team
• Develops, evaluates and implements survey tools
• Analyzes data from survey sources in order to provide input into improvement initiatives
• Coordinates and participates in quality improvement committee meetings; develops agendas, prepares meeting minutes, prepares and makes presentations, and follows-up on action items
• Communicates in a clear, concise, and complete manner with upper management, peers, department staff, other disciplines within the organization, outside agencies and other entities to ensure prompt and proper exchange of information and resolution of issues
• Assist with tracking, compiling and reporting program and project metrics
• Research, gather and analyze data to identify improvement opportunities
• Work closely with Maternal Child and Health Outcomes Management and Vendor Management to monitor vendor and community partner performance
• Monitor monthly/quarterly/annual reporting of vendors and ensure timely receipt and accuracy in completed material
• Participate in workgroups and applicable committees
• Prepare reports, briefing materials and other requested deliverables for programs and projects
• Perform any other job related instructions as requested

Education and Experience:

• Bachelor’s degree or equivalent years of relevant work experience is required
• Minimum of three (3) years of healthcare or managed care experience is required
• Experience using the Model for Improvement (PDSA – Plan, Do, Study, Act) is preferred
• Medicaid and/or Medicare experience is preferred

Competencies, Knowledge and Skills:

• Knowledge of a variety of quality improvement methodologies – Model for Improvement, Lean, Six Sigma
• Proficient in leading teams through establishing aim statements and identifying small tests of change
• Proficient in establishing and documenting PDSA cycles and key driver diagrams
• Excellent team facilitation skills
• Ability to engage teams in a positive, energetic manner
• Research, data analysis and trending
• Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
• Excellent written and verbal communication skills
• Ability to develop, prioritize and accomplish goalsAbility to work independently and within a team environment
• Attention to detail
• Familiarity of the health care field
• Familiarity with applicable Federal regulations, State regulations, and accreditation standards
• Effective listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Effective problem solving skills with attention to detail
• Training/teaching skills

Licensure and Certification:

• Certified Professional in Healthcare Quality (CPHQ) or American Society for Quality (ASQ) certification preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Some in state travel is required (up to 10% of time)

Compensation Range:

$62,700.00 - $100,400.00

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

Brand=CareSource The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be.