Medicare Clinical Quality Consultant

Cambia Health Solutions; Renton (WA); Remote; USD 86,000 - 141,000; Full time

Job summary

Cambia Health Solutions is seeking a Medicare Clinical Quality Consultant to develop quality improvement programs and ensure compliance with regulatory standards. This remote position requires strong leadership and analytical skills, focusing on enhancing healthcare outcomes for members.

Benefits

Generous paid time off

Market-leading retirement plan

Award-winning wellness programs

Employee Assistance Fund

Qualifications

• 8 years of progressive experience in health care administration, quality, or project leadership.
• RN/BSN clinical experience preferred.
• Participation in successful NCQA/URAC accreditation process preferred.

Responsibilities

• Develops and maintains quality program documents for compliance.
• Monitors exposure to accreditation risks and identifies improvement opportunities.
• Coordinates with accreditation entities for compliance and prepares submissions.

Skills

Knowledge of quality improvement processes

Leadership skills

Analytical skills

Communication skills

Education

Bachelor’s degree in business administration or related field

Job description

MEDICARE CLINICAL QUALITY CONSULTANT (RN PREFERRED) (HEALTHCARE)

Work from home (telecommute) within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia’s Medicare Quality Team is living our mission to make health care easier and lives better. The Quality Consultant Senior develops and implements quality improvement programs related to clinical quality measurement and outcomes and assists in resolving deficiencies that impact plan compliance to regulatory accreditation standards and/or quality measurement. Ensures activities meet regulatory requirements of the state or product and reflects Cambia’s quality strategies, approaches and work plans – all in service of making our members’ health journeys easier.

If you're a motivated and experienced People Leader with Medicare experience looking to make a difference in the healthcare industry, apply for this exciting opportunity today!

What You Bring to Cambia:

Preferred Key Experience:

• Clinical Experience (RN/BSN)

• Medicare STARS

• HEDIS

Qualifications and Certifications:

• Bachelor’s degree in business administration or related field

• 8 years of progressive experience in health care administration, quality, project leader or project support

• Equivalent combination of education and experience

Skills and Attributes (Not limited to):

• Knowledge of quality improvement processes and performance measurement and ability to develop and accomplish clinical quality measurement and/or program activities.

• Demonstrated ability to identify problems, develop solutions and implement a chosen course of action.

• Leadership skills with the ability to direct activities of others both individually and within a project team .

• Ability to organize, plan, prioritize and develop multiple projects within time constraints.

• Strong knowledge and understanding of data integrity/validity standards and significance.

• Ability to perform sound basic quantitative and qualitative analyses and interpretation.

• Knowledge of the healthcare industry, preferably in the managed care market.

• Excellent verbal and written communication skills including ability to communicate effectively across multiple areas and levels.

• Participation in successful NCQA/URAC accreditation process, AND/OR full HEDIS production reporting and continuous process improvement experience preferred.

• Previous participation in successful completion of the NCQA/URAC accreditation process and continuous process improvement experience in an NCQA/URAC setting.AND/OR prior responsibility for annual HEDIS production including audit and medical record collection.

What You Will Do at Cambia (Not limited to):

• Develops and maintains required/applicable quality program documents, including a standardized quality management plan and program to ensure compliance with external regulatory and accreditation and/or performance measurement requirements.

• Serves as a point of contact, coordinating and collaborating with accreditation entities and business partners to ensure compliance with accreditation and/or performance measurement requirements. Prepares enterprise for accreditation and/or performance measurement submissions and reviews.

• Serves as the subject matter expert for applicable accreditation standards/measurement requirements. Makes recommendations to business unit partners for improvements or remediation to accreditation/reporting compliance/improvement programs.

• Monitors exposure to accreditation/measurement risks and identifies opportunities to manage and mitigate those risks.

• Compiles information related to quality improvement and accreditation monitoring activities for internal use and external audits and maintains relevant records.

• Assists with the development and maintenance of required quality program documents. Responsible for reporting activities to the quality committee and management.

• Responsible for managing and coordinating quality committees, including committee scheduling, workflows, production of contemporaneous committee minutes, reporting and processes in support of the Quality Program.

• Works with clinical and operational areas to develop performance metrics for monitoring program objectives. Identifies areas for improvement and implements interventions or corrective action plans as needed.

• Establishes and maintains tracking and monitoring systems for health quality improvement activities according to regulatory requirements, accreditation standards, policies and procedures and contractual agreements.

• Effectively keeps leaders informed through regular written and verbal project status communications.

• Effectively handles the most complex quality initiatives.

• Provides related training to new team members and other colleagues across the organization.

The expected hiring range for The Medicare Clinical Quality Consultant is $120k–$125k, depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15%. The current full salary range for this position is $86k Low/ $108k MRP / $141k High

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail] . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy .