Job Description

Job Brief

This position is remote eligible. Experience working with quality and HEDIS / STARS.

Your career starts now. We\xe2\x80\x99re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we\xe2\x80\x99re passionate about helping people get care, stay well and build healthy communities. As one of the nation\'s leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we\xe2\x80\x99d like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at .

As part of the Quality Management team, the Senior Quality Performance Specialist is responsible for the oversight, design, and implementation of quality projects ensuring identification of root cause, and with the assistance of the Quality Director establishes a work plan to implement interventions. This position will work in a collaborative manner with all providers, members, departments within AmeriHealth Caritas to conduct ongoing process and data review to identify opportunities for improvement.

The Senior Quality Specialist will be responsible for leading the development and implementation of interventions aimed at improving Service and Clinical Operation performance by:

• Performs ad-hoc analysis of any underperforming or \xe2\x80\x9cbroken\xe2\x80\x9d processes by collaborating with Subject Matter Experts and/or Customers to define existing processes and make recommendations for improvement.
• Leads organizational efforts in ongoing quality and STARS improvement processes to ensure compliance with State, Federal, regulatory and accrediting body\xe2\x80\x99s standard requirements
• Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies.
• Removes barriers to achieve successful completion of strategic projects aimed achieving desired outcomes for HEDIS and STARS goals.
• Conducts analysis and provides summary reports and analysis to senior management
• Supports Medicare HEDIS project
• Monitoring Stars key performance indictor data and reports. Includes data manipulation and analysis.
• Maintains quality dashboards.
• Collaborates with Provider Network Management to complete analysis of annual surveys (Access to Care Survey and After Hours) survey and works with all areas to integrate results into departmental goals.
• Serves as lead resource to department and other departments
• Maintains and tracks AOP initiatives and outcomes.

The Quality Specialist, Senior will play an integral role in the plan\xe2\x80\x99s quality improvement program with focus on preventive health programs, analysis and clinical/service quality improvement, as well as, HEDIS, CAHPS and Health Outcomes Surveys (HOS). In addition, facilitates a quality improvement / STARS philosophy throughout the organization and promotes the use of quality process (PDSA) and decision-making.

In addition, the Senior Quality Specialist is responsible for taking on other responsibilities that support the day-to-day operations.

• Acts as a primary liaison and contact to internal departments that require collaboration and coordination, to include Case Management, Community Outreach, Pharmacy, Operations, Appeals, Grievances and Compliance.
• Coordinates and monitors day to day assignments, educations coordination, progress towards goals and assist with management reports / presentations. Documentation of workflows.
• Acts as a mentor for all new hire positions in order to ensure uniformity of information/training.

Education & Experience:

• Associate\xe2\x80\x99s Degree, or the equivalent work experience required, Bachelor\xe2\x80\x99s Degree preferred
• Clinical background preferred (RN / LPN)
• Minimum of 5 years in clinical or service quality improvement required
• Minimum of 5 years in healthcare delivery required
• Successful management of NCQA accreditation survey preferred
• Excellent organizational, analytical and interpersonal skills.
• Excellent written and verbal communication skills.
• Ability to work successfully within all levels of the organization.
• Ability to design, develop and implement projects to address financial, quality and service improvements.
• Proficient PC skills in a windows based environment: Intermediate to Advance Excel

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