Quality Performance Specialist

Reporting to the Director of Quality Management, the Quality Performance Specialist is responsible for the coordination and ongoing monitoring of QI program objectives, including the delivery of performance improvement projects for service and clinical activities, integrating the quality improvement plan into all departments and facilitating HEDIS, CAHPS and NCQA accreditation activities. Implements and supports the overall implementation of quality programs that meet or exceed applicable State, Federal and NCQA standards.

Principal Accountabilities include, but not limited to:

• Leads organizational efforts in ongoing quality improvement processes to ensure compliance with State, Federal, regulatory and accrediting body’s standard requirements.

• Leads the cross organizational preparation for the NCQA accreditation survey project.

• Responsible for completion and analysis of annual HEDIS/CAHPS results and works with all areas to integrate improvement initiatives into departmental goals.

• Responsible for the successful implementation of the QI work plan and program description by facilitating QI throughout the organization.

• Responsible for overall oversight, administration, development, and strategic planning for the CLAS (Cultural and Linguistically Appropriate Services) program and access for culturally diverse, multi-lingual population.

• Maintains a comprehensive knowledge of Department of Public Welfare (DHH), National Committee on Quality Assurance (NCQA), Office of Minority Health (OMH) and other regulatory standards related to Cultural and Linguistically Appropriate Services activities.

• Develops and submits documentation and updates required to meet CLAS compliance including Annual Work Plan, Program Description, and Program Evaluation, etc.

• Identifies resolves and/or escalates problematic QI areas that may place plan at risk of not achieving annual goals.

• Collaborates with Provider Services and Member Services to complete analysis of annual satisfaction surveys and works with all areas to integrate results into departmental goals.

• Responsible for oversight of delegated entities pertaining to quality improvement and credentialing policies and standards.

• Participates in the development, implementation and maintenance of QI policies and procedures.

• Serves as a resource to other departments in completing QI goals.

• Works professionally and efficiently with all functional areas in meeting organizational and departmental quality goals.

• Participates on QI committees structured to achieve outcomes success and completes committee documentation that is consistent in meeting applicable requirements.

• Bachelor’s degree in health care related field or equivalent education and experience preferred.

• Preferred BSN/RN preferred not required

• Minimum of 5 years’ experience in healthcare delivery required (Managed Healthcare experience preferred).

• Minimum of 3 years’ experience in clinical or service quality improvement required.

• Successful management of NCQA accreditation survey preferred.

• Two years managed Medicaid experience preferred.

Kind Regards,

Kavita Kumari

Clinical Recruiter

Integrated Resources, Inc.

IT Life Sciences Allied Healthcare CRO

DIRECT # - 732-844-8726