at PacificSource in Boise, Idaho, United States
Job Description
Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
The Quality Programs Strategist is responsible for developing, implementing and monitoring strategies to enhance quality performance and improving member outcomes. This role focuses on optimizing key quality measures including but not limited to HEDIS, CAHPS, HOS, CMS Star Ratings and OHA Quality metrics. The Quality Programs Strategist will influence cross-functional teams aimed at driving measurable improvements, member experience and quality performance. This includes developing, implementing, and leading enterprise initiatives to support success. This role will collaborate with clinical, operational, population health and other quality leaders to identify performance trends, develop innovative solutions, implement strategies and monitor performance to ensure continuous improvement. The Quality Programs Strategist will support program metrics of diverse scope and complexity.
Essential Responsibilities:
- Partner with Quality management to design multi-year improvement plans for designated quality program aimed at enhancing gap closures, operational efficiency and performance outcomes to ensure members have access to high value care. This includes developing, implementing, and leading enterprise initiatives to support success.
- Oversee development and execution of quality improvement strategies and plans to meet or exceed enterprise goals/targets.
- Lead and influence cross-functional teams that oversee implementation of quality metric strategies and improvement initiatives.
- Develop and monitor dashboards, scorecards and programmatic reporting to track metric level performance against quarterly and annual program goals.
- Collaborate with population health, care management, pharmacy and other internal teams to implement targeted interventions.
- Manage timelines, deliverables and communications for quality projects and improvement initiatives
- Conduct ongoing assessments to identify underperforming metrics or trends and collaborate with cross-functional teams to ensure successful end-to-end execution of strategic initiatives.
- Work with clinical, operational and quality leaders to develop metric level KPI's, establish and operationalize continuous monitoring mechanisms to identify areas of improvement and implement interventions or correction action plans.
- Partner with metric owners to establish tracking and monitoring systems to evaluate the effectiveness of quality interventions and make recommendations to improve outcomes.
- Provide subject matter expertise on assigned quality metrics, current interventions and performance improvement opportunities.
- Work with Quality management to oversee day-to-day program operations, while mapping futuristic needs and enhancements.
Supporting Responsibilities:
- Identify and communicate opportunities and risks to business owners and quality management to anticipate downstream performance impacts.
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: Minimum of 5 years of experience in a managed healthcare field required. Experience directly related to health plan quality required.
Education, Certificates, Licenses: Bachelor's degree in public health, health care administration or related field required, or equivalent years of additional experience in lieu of degree required. Master's degree and Project Management Certification (PMP) are preferred.
Knowledge: Demonstrated ability to identify problems, develop solutions and implement a defined course of action. Strong analytical skills with the ability to synthesize complex data sets. Ability to organize, plan, prioritize and develop multiple projects within time constraints. Must have knowledge of HEDIS, HEDIS-like metrics, CAHPS, quality interventions and reporting. Ability to work independently under general instructions, self-directed and motivated.
Competencies
Adaptability
Building Customer Loyalty
Building Strategic Work Relationships
Building Trust
Continuous Improvement
Contributing to Team Success
Planning and Organizing
Work Standards
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.
Skills:
Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
- We are committed to doing the right thing.
- We are one team working toward a common goal.
- We are each responsible for customer service.
- We practice open communication at all levels of the company to foster individual, team and company growth.
- We actively participate in efforts to improve our many communities-internally and externally.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
- We encourage creativity, innovation, and the pursuit of excellence.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times. To view full details and how to apply, please login or create a Job Seeker account
