The Quality Operations Coordinator is responsible for monitoring performance of quality programs and improvement initiatives for various quality incentive programs (Medicaid Quality Incentive Program (QIM), Medicare CMS Stars and Commercial NCQA). This position reports to the Quality Performance Manager and will work with various internal and external stakeholders as needed. The Quality Operations Coordinator will oversee multiple improvement projects including provider education, member engagement, measure specific initiatives aimed to improve clinical quality outcomes and member experience. This position will provide key supports for annual submission tasks and data validation as needed.
- Serve as a QI subject matter expert and effectively share expertise with internal and external stakeholders.
- Collaborate with cross-functional teams (Care Management, Quality, Population Health and Provider Network) to execute on quality improvement projects (internal and external).
- Assist with the development, production and accuracy of quality performance dashboards, gap in care lists and other reporting as requested.
- Support the end-to-end project management of quality metrics and improvement initiatives in coordination with the assigned Program Manager.
- Use appropriate project management tools to coordinate, measure, and support assigned projects.
- Learn and understand existing Quality, Risk, and Population Health business processes. Determine opportunities for operational improvement and support of strategic goals.
- Champion quality metric improvement projects including facilitating project meetings, work plans, risk mitigation and driving outcomes in collaboration with various Program Managers and Quality Performance Manager.
- Cultivate integration and collaboration of physical, dental, behavioral health improvement efforts to optimize outcomes and member experience.
- Assist with compliance activities including preparation of relevant documents, reports and annual work plans.
- Demonstrates strong communication skills (verbal and written) to ensure effective and successful relationships and follow through.
- Utilize lean methodologies to identify process improvement and cultivate a culture of continuous improvement.
- Serve as a BH subject matter expert and effectively share expertise with internal stakeholders including, but not limited to Care Management, Quality Improvement, Population Health, and Provider Network.
- Development and deploy of provider training and education as needed.
- Meet department and company performance and attendance expectations.
- Perform other duties as assigned.
Project coordination or project management experience in a complex environment required. Three years of experience in the healthcare industry, provider organization, or related area. Relevant experience in the following areas: healthcare operations, community health, quality improvement, strategic relationship development, and population health improvement. Knowledge of quality programs and quality metrics for OHA QIM, CMS STARS, HEDIS, and/or NCQA preferred.
Education, Certificates, Licenses:
Bachelors or equivalent degree desired. Billing/coding experience desired.
Knowledge and understanding of disease prevention, medical procedures, care modalities, procedure codes, including ICD-10, CPT Codes, health insurance, and State of Oregon mandated benefits. Ability to develop, review, and evaluate utilization reports. Knowledge of quality improvement methodology. Experience giving presentations. Organizational skills with solid experience in using computers and various software applications including Word, Excel, PowerPoint, Outlook, SharePoint, and audio-visual equipment. Ability to work independently with minimal supervision.
Work inside in a general office setting with ergonomically configured equipment. Travel within the region is required approximately 25% of the time. Infrequent overnight travel.
- 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 encourage creativity, innovation, and the pursuit of excellence.
- We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
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.
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 apply for this job please visit pacificsource.wd5.myworkdayjobs.com.