Senior Clinical Quality Performance Specialist

IntelliResume; New Hampshire; On-site; USD 90,000 - 120,000; Full time

Job summary

AmeriHealth Caritas is seeking a Senior Clinical Quality Performance Specialist in Manchester, NH, with remote flexibility for NH residents. The role focuses on overseeing, designing, and implementing quality initiatives using data analytics to drive improvements in clinical quality performance.

The position emphasizes HEDIS support, accreditation activities, and mentorship of staff, collaborating with internal departments to ensure successful, high-quality outcomes.

Qualifications

• RN license required.
• Associate degree or equivalent required.
• 5 years of experience in clinical or service quality improvement.
• 5 years of experience in managed care.

Responsibilities

• Provide key data analysis and critical thinking for quality improvement project interventions.
• Develop reports and analyses, and present findings to the Quality Committee.
• Support HEDIS and Clinical Practice Guidelines.
• Support accreditation activities and clinical quality performance improvement initiatives.
• Perform ad-hoc analyses of underperforming processes with SMEs and internal stakeholders.
• Remove barriers to ensure successful completion of strategic quality projects.
• Conduct analyses and provide summary reports to senior management.
• Act as a primary liaison to internal departments for collaboration and coordination.
• Support the development of new and existing staff by identifying learning opportunities.
• Serve as a mentor to new hires, ensuring consistency in information and training.

Skills

Data analysis

Quality improvement

Managed care experience

Stakeholder collaboration

Education

Associate's degree or equivalent

Registered Nurse (RN) license

Job description

About This Role

The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, utilizing data analytics to identify opportunities for improvement. This role is ideal for individuals with strong analytical skills and experience in clinical quality performance.

Highlights

• Location: Manchester, NH
• Schedule: Full-time, Remote (must be located in NH)

What You'll Do

• Provide key data analysis and critical thinking for quality improvement project interventions.
• Develop reports and analyses, and present findings to the Quality Committee.
• Support HEDIS and Clinical Practice Guidelines.
• Support accreditation activities and clinical quality performance improvement initiatives.
• Perform ad-hoc analyses of underperforming processes with SMEs and internal stakeholders.
• Remove barriers to ensure successful completion of strategic quality projects.
• Conduct analyses and provide summary reports to senior management.
• Act as a primary liaison to internal departments for collaboration and coordination.
• Support the development of new and existing staff by identifying learning opportunities.
• Serve as a mentor to new hires, ensuring consistency in information and training.

Requirements

Education

• Associate's Degree or equivalent work experience required.
• Registered Nurse (RN) required.

Experience

• 5 years of experience in clinical or service quality improvement required.
• 5 years of experience in managed care required.

Licenses & Certifications

• Unrestricted Registered Nurse license in the plan's state or any state in which the individual works.

About AmeriHealth Caritas

AmeriHealth Caritas is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes for their members through quality services and innovative solutions.