Quality Improvement Professional

The Quality Improvement Professional 1 will support clinicians and staff, working collaboratively with the Stars Clinical Quality RN/s, to support staffed clinical and operations teams including center administrators. Provide support, make recommendations and assist with implementing quality improvement best practice initiatives designed to improve Medicare quality measures (HEDIS), patient safety and patient experience (CAHPS-HOS). QIP assignment may be coverage of Conviva PCO staffed providers and or PCO Independent Network provider/practices functioning in a similar capacity as described previously for support to the staffed centers.

• Best suited candidate will have an interest and practical experience working with clinical quality measures in particular medication adherence and HEDIS.
• Utilize approved avenues to outreach to patients with medication reminders
• Medical record review, retrieval, and submissions to health plans to support HEDIS gap closure.
• Distribute time-sensitive and actionable data to promote action on the part of clinical teams and operations to address opportunities and close gaps (excel moderate -to- advanced skills)
• Review and assess provider/member detail HEDIS data/gap reports to identify opportunities for improvement and gap closure.
• Using critical thinking skills, QIP 1 leads efforts to identify opportunities for improvement, workflow deficiencies and barriers.
• Provides support to provider/practice specific needs thus assisting in driving the effective implementation of the quality improvement strategy.
• Manage workloads, having the ability to meet time-sensitive deadlines such as the distribution of medication adherence reports to PCP.
• Train/educate teams on CMS Star measures, one-on-one or in a setting with multiple team members (clinicians, medical assistants, practice administrators, front office).
• The candidate must have excellent interpersonal skills as well as the ability to develop working relationships and partnerships. Must be a "people person" since the role requires seamless teamwork to achieve targets/meet goals.
• Present STARs performance information during meetings one-on-one or in wider settings. Create PowerPoint presentation.
• Collaborates with various stakeholders/partners (internal and external) including market operations/provider relations, coding teams; medical directors, clinical and health plan teams, and vendors to provide support and in some cases assist with the execution of workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.
• Support quality initiatives eye screenings, bone mineral density, mobile mammogram etc.

Required Qualifications:

• Understanding of healthcare quality measures STARS (HEDIS, Patient Experience (CAHPS/HOS) and Patient Experience in particular knowledge of the measure technical specifications etc.
• Minimum of 2 years' experience working with CMS STARs quality measures.
• Prior experience in a fast-paced health care setting direct hands-on patient care, front office or provider relations field.
• Experienced providing training 1:1 or in a group setting.
• Ability to work independently but within team guidelines and standardized workflow.
• Comprehensive knowledge of Microsoft Office Word, Excel and PowerPoint and excellent communication and presentation skills
• Must be willing and able to travel locally, to our CenterWell/Conviva Centers in and around the Houston, Texas area.

Preferred Qualifications:

• Bachelor's or Associate's Degree
• Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.
• Knowledge of Humana's internal policies, procedures, and systems.

Additional Information:

• Work schedule: M-F, 8AM-5PM. Occasional after 5PM meetings
• Work-at-home and visits to various medical centers and or IPA offices
• Must reside in and around the Houston, Texas areas

Work At Home Statement:

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly