Quality Improvement Project Coordinator
Company: Highmark Health
Location: Santa Fe
Posted on: January 27, 2023
Job Description:
Company :Highmark Inc.Job Description :Job DescriptionDuties
Note: The following is not intended to be an exhaustive list of all
duties required of this position.ADAE1. Thoroughly reviews data,
trends, and best practices to identify projects and approaches
toward achieving excellence in area(s) of focus, including a 4 to 5
Star Rating in the CMS STAR Rating System, a 4 to 5 star rating in
the QRS Rating System, and compliance with NCQA Accreditation
standards.E2. Leads focused workgroups to identify areas of
improvement, develop and implement QI strategies, and ensure
compliance with regulatory/accreditation bodies. Tracks progress
and coordinates recommendations from workgroup members. Reports
progress and workgroup recommendations to Quality Rating Oversight
Committee (QROC) and progress on initiatives to the Quality
Management Committee.E3. Interfaces and coordinates efforts with
various departments/vendors/contracted partners to develop and
implement strategies that will address overall quality improvement,
ensure compliance with regulatory requirements (NCQA, HEDIS, CMS,
DOH, QRS), and align with corporate priorities.E4. May serve as
primary contact for HealthNow, New York Inc. and/or BlueCross
BlueShield of WNY with the NYS DOH and other regulatory bodies as
it relates to reporting requirements and quality improvement, e.g.
Quality Assurance Reporting Requirements (QARR).E5. Participates in
BlueCross and BlueShield Association Quality workgroups.N6.
Coordination and oversight of readiness surrounding NCQA
accreditation including conducting mock surveys to ensure
compliance with accreditation standards, and coordination of
evidence needed in preparation for audit requirements for all
accreditation products and markets.E7. Coordination of annual
review of corporate administrative policies and procedures related
to quality, accreditation and regulatory compliance.E8. Manages
projects and initiatives within the area of Health Care Quality
Improvement & Reporting as needed.N9. Performs other duties as
requiredEducation/Experience/Skills RequirementsRequired
Education:Bachelors Degree: Business Admin., Healthcare
Administration or related area. Masters Degree preferred. In place
of a Bachelors Degree, an Associated Degree and 10 years of
experience will suffice.Required Experience:Minimum of 5 years
healthcare related work experience with minimum 3 years experience
managing projects. If Project Coordinator focus is Accreditation &
Regulation, specific experience in those areas is
preferred.Required Knowledge/Skills:
- Knowledge of care management, managed care, health insurance
industry, and the provider community. For Accreditation &
Regulatory focus, thorough knowledge of DOH and CMS regulations and
the reporting requirement components.
- Excellent verbal and written communication skills
- Ability to work effectively and manage multiple projects with
minimal supervision
- High degree of business maturity and demonstrated
confidentiality
- Strong organizational and leadership skills with the ability to
manage multiple conflicting priorities
- Polished, professional image and reputation
- Demonstrated personal accountability
- Excels in a team environment
- Project management or process improvement experience
- MS Word, Excel, PowerPoint
- Strong presentation skills
- Knowledge of Medicare processes/systems is a plusRequired
Licenses/Certifications:N/AProblem Solving
- Identifying issues and problems- Recognizing major issues;
identifying key facts; trends, and issues; separating relevant from
irrelevant data. 2. Seeking information - Identifying/recognizing
information gaps or the need for additional information; obtaining
information by clearly describing what needs to be known and the
means to obtain it; questioning clearly and specifically to verify
facts and obtain the necessary information. 3. Seeing relationships
- Organizing information and data to identify/explain trends,
problems, and their causes; comparing, contrasting and combining
information; seeing associations between seemingly independent
problems or events to recognize trends, problems and possible
cause-effect relationships. 4. Proactively identify, evaluate, and
solve problems with a rigorous logic and a systematic approach, and
look beyond the obvious to see root cause issues and develop
creative solutions.Managerial/Supervisory ResponsibilitiesDoes this
Position have Supervisory Responsibility? NoNumber of Emps
Supervised:Titles of Employees Supervised:Financial/Budgetary
Responsibilities:NoneOther Job Specifications:External Contacts:
Providers, MembersWorking Conditions/Physical Demands:Position
requires:
- Must be able to work in an office environmentPosition involves:
- Manual Dexterity Req: Eye-hand coordination and manual
dexterity sufficient to effectively use a computer with all its
components for prolonged periods of time and for the majority of
required tasks
- Manual Dexterity Req: Eye-hand coordination and manual
dexterity sufficient to effectively utilize various office
equipment (phone, computer, fax machine, printer, copier, filing
cabinet, etc)
- Heat, light, air, space and working environment typically found
in an office environment
- Mental effort: Adequate to perform essential functions of the
job with the type of judgements and responsibilities as indicated
in the job description.Pay Range Minimum:$57,700.00Pay Range
Maximum:$106,700.00Base pay is determined by a variety of factors
including a candidates qualifications, experience, and expected
contributions, as well as internal peer equity, market, and
business considerations. The displayed salary range does not
reflect any geographic differential Highmark may apply for certain
locations based upon comparative markets.Highmark Health and its
affiliates prohibit discrimination against qualified individuals
based on their status as protected veterans or individuals with
disabilities, and prohibit discrimination against all individuals
based on their race, color, age, religion, sex, national origin,
sexual orientation/gender identity or any other category protected
by applicable federal, state or local law. Highmark Health and its
affiliates take affirmative action to employ and advance in
employment individuals without regard to race, color, age,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability.EEO is The LawEqual
Opportunity Employer Minorities/Women/Protected
Veterans/Disabled/Sexual Orientation/Gender Identity (
https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf
)We endeavor to make this site accessible to any and all users. If
you would like to contact us regarding the accessibility of our
website or need assistance completing the application process,
please contact number below.For accommodation requests, please
contact HR Services Online at
HRServices@highmarkhealth.orgCalifornia Consumer Privacy Act
Employees, Contractors, and Applicants NoticeReq ID: J218802
Keywords: Highmark Health, Santa Fe , Quality Improvement Project Coordinator, Other , Santa Fe, New Mexico
Didn't find what you're looking for? Search again!
Loading more jobs...