Job Details
Job Location: Any Location Remote US - Oklahoma City, OK 73102
Position Type: Full Time
Education Level: 4 Year Degree
Job Shift: Day
POSITION SUMMARY:
Provides guidance, and training to the Quality department and organization-wide staff that impact member experience improvement initiatives. This position will ensure the effective management of member experience survey ratings, including member and provider outreach.
ESSENTIAL DUTIES AND RESPONSBILITIES:
- Develops, plans, and implements initiatives and other quality member experience improvement strategies, making recommendations for change as needed.
- Directs the member experience processes to ensure the health plan is NCQA-accredited and is a 4+ STAR rating.
- Ensures pre-CAHPS member surveys are fielded on a monthly basis and communicates results with external provider groups
- Build and maintain relationships with other departments internally, as well as external provider groups, as it relates to STARS and NCQA.
- Implements survey improvement initiatives including CAHPS committee meetings to ensure company-wide involvement to increase member survey scores.
- Creates wellness materials for marketing distribution to aid in member retention and health improvement efforts.
- Maintains an expert technical understanding of HEDIS, CAHPS, HOS, NCQA and Meaningful Use measures set by CMS performance standards.
- Manages and monitors performance for CAHPS/HOS survey vendor
- Develops and implements Medicare AWV/HRA program to increase provider and member participation
- Sets actionable and achievable goals for Quality Department implementation toward earning and maintaining a 4 STAR
- Creates training material on member experience surveys for organization-wide staff.
- Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
- Performs other duties as assigned
EDUCATION AND EXPERIENCE:
- Bachelors degree or equivalent experience required
- 5-years experience in a clinical or health insurance setting required
- 5-years experience managing data to create reports required
- Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred
- Requires a valid state Drivers License
KNOWLEDGE, SKILLS AND ABILITIES:
- Ability to communicate and manage complex working relationships
- Ability to train internal and external parties
- Strong organizational, verbal, written, time management, and telephone skills
- Computer literate and familiar with Microsoft applications (Word, Excel, Outlook)
- Basic electronic health record knowledge and ability to quickly learn new software
- Detailed knowledge of quality performance measures and clinical health care
- Ability to collaborate across departments
WORK ENVIRONMENT:
- This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
- This is a largely sedentary role; however, some filing is required, which would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.
- May need to lift to 25lbs.
TRAVEL:
- Required travel to present Quality survey updates to in-network provider groups as well as educational conferences for updates on measures or best practices
SUPERVISORY RESPONSIBILITY:
- This position has no direct supervisory responsibilities but does serve as a coach and mentor for other positions in the organization that contribute to member experience ratings.
OTHER DUTIES:
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Qualifications