Quality Improvement Specialist - Health Plan

 
Position: Quality Improvement Specialist - Health Plan

Job ID: 154621

Location: US-TX-Bellaire

Department: Quality Management

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

Founded 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.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Quality Improvement Specialist -- someone who works well in a fast-paced setting. In this position, you will lead process improvement using QI methodology, coordinate quality improvement committees and advisory committees, complete regulatory reporting requirements, and lead provider site process improvement.

Think you’ve got what it takes?



Responsibilities :

  • Lead process improvement to meet assigned objectives defined by the Quality Improvement Program (QI Program)
  • Leverage analytics tools to identify opportunities to close HEDIS gaps to improve overall HEDIS compliant rates
  • Serve as the organization’s subject matter expert on all technical specifications for HEDIS measures
  • Coordinate and support the organization’s Quality Improvement Committee and external advisory committees
  • Lead process improvement at provider sites to support provider’s performance on high impact quality measures and adherence to clinical practice guidelines
  • Lead provider audit activities to advise corrective action in response to complaints or concerns regarding a provider in our provider network
  • Complete regulatory reporting requirements related to oversight of MCO Quality performance
  • Conducts medical record reviews and abstracts needed information for annual HEDIS regulatory requirement


Qualifications:

  • Bachelor’s degree required
  • 1-year Project management or process/quality improvement experience required
  • Knowledge of population health quality measurement standards including but not limited to NCQA’s HEDIS measures, AHRQ’s CAHPS Surveys, and 3M’s PPEs


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