About Texas Children's HospitalFounded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
We are searching for a Senior Quality Improvement Specialist— someone with enthusiasm for leading process improvement! In this position, you will lead process improvement across the health plan to improve our performance on quality measures and improve operations to establish NCQA Accreditation. Responsibilities of this role are diverse and will expose you to various parts of the health plan and the Texas Children’s integrated delivery system.
Think you’ve got what it takes?
• Establish the annual QI work plan for each assigned QI objective, which includes calculating baseline performance and establishing surrogate markers to measure progress toward aim, developing QI tools to organize and communicate the work plan, and completing standard report outs to communicate QI progress to leadership
• Lead process improvement work groups, which can include building a cross-functional process improvement team, completing cause/effect analyses using internal and external sources, developing key driver diagrams to connect interventions with aim, leading rapid PDSA cycles, and pivoting interventions based on the outcomes
• Incorporate high-impact population health interventions into process improvement by reviewing relevant, evidence-based literature in quality improvement, implementing population health interventions used by other health plans for improvement on nationally used quality measures
• Design, extract, and analyze the health plan’s quality outcomes data, manage data in Microsoft Excel at an advanced level, use business intelligence tools to capture data, extract and interpret data produced by third party quality analytics vendors, and complete quantitative and qualitative analyses of quality-related data
• Research and summarize market and industry trends for review by the quality leadership team
• Gather and analyze best practices to improve HEDIS and CAHPS scores
• Make recommendations for consideration by the quality leadership team based on the assessment results
• Use the analysis of documentation and models to create and design new processes and improvements to existing processes
• Serve as the subject matter expert on all technical specifications for assigned HEDIS measures and proactively manage data collection, electronic medical record data integration, administrative data integrity, supplemental data optimization, and medical record reviews
• Lead the CAHPS shadow survey performance, design and modify drill down questions, identify leading providers to focus on, ensure minimal member abrasion, enhance gathering methods, and respond to trends
• Develop provider facing quality analytics, lead office improvement activities, and develop provider education materials/tools to aid in process improvement
• Perform appropriate audit in response to a quality of care concern
• Conduct medical record reviews and abstracts needed for the annual HEDIS regulatory requirement
• Bachelor’s degree
• 3 years’ experience in project management or process/quality improvement
• Knowledge of population health quality measurement standards such as HEDIS, CAHPS, and 3M’s PPEs preferred