Job Summary
This position is responsible for supporting population health, quality improvement, and value-based care initiatives through close collaboration with provider groups, clinicians, and internal business partners. Responsibilities include embedded provider support, member outreach, care gap identification and closure activities, provider education, quality measure improvement, and implementation of clinical and operational strategies that enhance preventive care, improve health outcomes, and support value-based care objectives.
Required Job Qualifications
- Registered Nurse (RN) or Registered Physician Assistant (RPA) with current, unrestricted license in the state of operations.
- 2 years’ experience using accreditation agency programs.
- 3 years of medical surgical and/or Quality Improvement and Utilization Review experience.
- 2 years of leadership or supervisory experience.
- Knowledge of medical terminology and procedures.
- Experience in using Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.
- Analytical skills to analyze data and prepare reports.
- Verbal and written communications skills in preparing recommendations and written documentation in appropriate format and facilitating work groups.
- 5 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.
- Project management experience and skills
- PC experience utilizing Microsoft Windows based products and database experience.
Preferred Job Requirements
- Possesses advanced technical knowledge of HEDIS methodology, measure specifications, numerator/denominator logic, exclusion criteria, care gap identification, and provider performance improvement, supported by direct HEDIS quality experience.
- 8 years' hands-on Medicare Stars and HEDIS experience with direct accountability for improving quality measures, closing care gaps, increasing Star ratings, and delivering measurable improvements in provider performance and member outcomes.
- 3 years' leading quality consultants, practice consultants, provider engagement teams, or population health staff with documented success improving HEDIS, Stars, quality, utilization, or performance metrics across multiple provider groups.
- 5 years' partnering directly with physician practices, medical groups, health systems, ACOs, or clinics to implement quality improvement initiatives, practice transformation efforts, and performance improvement strategies.
- Experience managing relationships with a multiple providers, physician groups, or practice leaders while influencing clinical and operational changes that resulted in measurable quality improvements.
- 5 years' supporting population health, preventive care, chronic disease management, care management, or value-based care programs within a health plan, provider organization, or healthcare system.
- Demonstrated success conducting provider and member outreach programs that closed annual care gaps and improved preventive screening rates, medication adherence, risk capture, or chronic condition management outcomes.
- 3 years' utilizing EMR/EHR data, HEDIS reports, care gap reports, provider scorecards, and quality dashboards to identify trends, monitor provider performance, develop action plans, and drive measurable quality improvement results.
Flex employees are expected to be in the office a minimum of three days a week. Management will have discretion to modify an employee's weekly schedule for exigent circumstances.
Base Pay Range
$84,400.00 - $152,300.00
Exact compensation may vary based on skills, experience, and location.