Provider Quality Engagement Specialist

EmblemHealth; New York (NY); Remote; USD 56,000 - 99,000; Full time

Job summary

EmblemHealth is seeking a Quality Improvement professional to lead provider-focused initiatives. You will build and sustain relationships with external providers, monitor performance, and drive strategic improvements across HEDIS and CAHPS measures within a multi-stakeholder environment.

You will collaborate with Provider Network, Product, IT and Marketing to align strategies, develop cross-functional teams, and ensure actions translate into measurable outcomes.

Qualifications

• Bachelor's Degree in a health services field required.
• Master's degree in public health, public administration, social work, or health services preferred.
• 3-5 years' experience in a health care related field, preferably managed care (Required).
• Quality improvement experience in a managed care environment (Preferred).
• Proficient in Microsoft Office (Word, Excel, PowerPoint)
• Ability to develop cross-functional teams and work collaboratively with different levels of staff (Required)
• Familiar with and have a working knowledge with QI process improvement methodology strategies (e.g. PDSA) (Required)
• Possess understanding of quality measures including HEDIS, QARR, CAHPS (Required)
• Superior planning and organizational skills to collect, organize and present information clearly (Required)
• Ability to travel to provider accounts and work with team member's in several locations where the company has offices (Required)
• Experience with and proficient in reviewing and summarizing data into actionable and simple reports and presentations (Required)
• Ability to assess all work and prioritize as necessary to meet reporting timeframes and deadlines (Required)

Responsibilities

• Maintain key relationships with providers, office staff and other external stakeholders.
• Establish consistent communication and collaboration structure with assigned provider groups.
• Build relationships with internal stakeholders (e.g. provider network, marketing) and create cross-functional teams to create a more streamlined experience for the provider.
• Create and align shared understanding of quality goals.
• Implement processes for two-way data sharing and work with quality data team to develop structure.
• Review performance dashboards, highlight opportunities and translate findings into actionable interventions.
• Monitor and track quality performance against provider contracts; make recommendations to contracts to ensure goal alignment.
• Prepare reports, presentations and executive level summaries to share projects, processes, results and highlight collaboration efforts.
• Create action plans and workplans to achieve performance improvement in HEDIS and CAHPS results.
• Create engagement and quality educational tools which providers can utilize in their office.
• Improve the understanding of quality measures through the use of educational programs (e.g. lunch and learns, webinars) and increase satisfaction and improved gap in care outcomes.
• Share and roll-out provider incentive programs.
• Ensure compliance with regulatory bodies and accreditation; implement corrective action and performance improvement projects as needed.
• Recommend best practices and evidence-based guidelines for care integration, preventive care, care coordination and patient experience.

Skills

MS Office

Cross-functional teamwork

Quality improvement

Data analysis

Public health knowledge

Education

Bachelor's degree in health services

Master's degree in public health or related

Tools

Excel

PowerPoint

Data visualization

Job description

EmblemHealth is seeking a Quality Improvement professional to lead provider-focused initiatives. You will build and sustain relationships with external providers, monitor performance, and drive strategic improvements across HEDIS and CAHPS measures within a multi-stakeholder environment.

You will collaborate with Provider Network, Product, IT and Marketing to align strategies, develop cross-functional teams, and ensure actions translate into measurable outcomes.