Quality Improvement Specialist - Stars Ratings - UCare : Job Details

Work Location: Work from home

Position Description

As a Quality Improvement Specialist - Star Ratings, you will be responsible for the design, development, implementation, evaluation and reporting of one or more evidence based health improvement programs as they relate to the UCare strategic and annual quality plan. You will have primary accountability for leading teams, coordinating and collaborating with internal and external stakeholders, meeting project objectives and reporting to regulatory entities and UCare leadership on project status and outcomes. You will have responsibility for all project management and process improvement activities as they relate to your designated projects. Serve as the subject matter expert for assigned Star Rating measures. This includes maintaining full technical knowledge on the measure, such as how the measure is calculated, the UCare systems that support the measure, and its importance in the program. Provide industry guidance to internal staff.

• Provide consultative support to key measure owners who influence Star Rating measures. Partner with owner to identify opportunities and assist with developing action plans to execute interventions.

• Support the implementation of a data-driven Stars strategy, promoting the use of root-cause analyses and evidence-based best practices. Translate data into meaningful information, draw conclusions, and relate findings to industry standards. Leverage data to inform targeted strategies that indicate whom to engage, with what content and through which channel and frequency.

• Utilize strategic dashboards to aid organization in identifying current measure performance, measures at risk, trend review and overall forecast of measures.

• Effectively utilize performance improvement methodologies (i.e., Plan Do Study Act (PDSA)) in the development, refinement, and implementation of rapid-cycle performance improvement.

• Maintain company-wide Stars Work Plan, ensuring all interventions are well-documented and up to date.

• Collaborate and coordinate a wide variety of trainings to improve at the department level an understanding of Stars and improve the culture of quality across the organization.

• Responsible for project management of complex quality improvement activities. This includes both leading and/or participating as a team member on various projects. Responsible for overseeing and managing project plans, timelines, interventions, quantitative project data, and development of measures to effectively assess effectiveness and return on investment.

• Develop key deliverables which may include, but are not limited to, regulatory reports, presentations and status updates. Responsible for identifying and addressing project barriers and reporting progress to appropriate UCare leadership.

• Participate in ensuring that UCare is compliant with regulatory requirements for quality. This includes an understanding of applicable State, Federal, and Medicare Star Rating requirements and the ability to keep updated with any new requirements and to modify projects, as needed.

• Active participant or leader in internal and/or external collaborative meetings and work groups as they relate to projects. This includes attending and actively participating in external meetings with regulators, other health plans, community, and stakeholder groups.

• Develop and maintain partnerships with community groups that share a common project goal. Align outreach and initiatives to target health needs in our diverse membership.

• Provide regulatory quality expertise to external organizations with a business relationship with UCare. This includes oversight for organizations for which UCare has delegated authority or to organizations for which UCare has contractual arrangements for consultation for design and implementation of quality improvement activities.

• Represent UCare's quality initiatives with key provider groups to develop a mutual understanding of shared quality improvement goals. This may include communicating UCare's quality strategy, gathering information on quality initiatives from the provider groups, and providing expertise, tools, and resources as appropriate.

• Align with strategic and departmental goals to develop and support new and ongoing project efforts as they relate to the Quality Improvement team. This includes, but is not limited to, supporting the development and implementation of Medicare Star Rating improvement initiatives, Performance and Quality Improvement Project (PIP and QIP) development, delegated quality activities, provider incentive and partnership strategies, HEDIS, NCQA, delegation oversight, surveys and other quality initiatives.

• Provide education and tools to improve company knowledge of quality improvement and processes. Define appropriate measures of processes and outcomes.

• Maintain knowledge of industry trends and practices.

• Other projects and duties as assigned.

Education

Bachelor's degree in business administration, health care, information systems, social sciences, public health or other related field required. Master's and/or nursing degree preferred.

Required Experience

At least five years of experience in a health care delivery system with a minimum of two years of experience leading/managing quality improvement initiatives. Demonstrated process improvement and project management skills. Strong verbal and written communication skills.

Preferred Experience

Experience supporting Medicare Star Rating improvement efforts. Formal training in quality improvement and/or project management. Education in statistical analysis and experience in a managed care or health insurance setting.