Quality Improvement Specialist

Job Number: 3243

Workplace Type: Hybrid Remote

Position Title: Quality Improvement Specialist

External Description:

Quality Improvement Specialist

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

 Position Summary:

The Quality Improvement Specialist is responsible for quality and performance improvement activity within the Medicare STAR program, including project management, process improvement, campaign coordination, and outcomes measurement. This position has a specific focus on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, and member experience and satisfaction. The ideal candidate possesses a deep understanding of the CAHPS survey and its impact to Medicare STAR.

General Duties/Responsibilities:

(May include but are not limited to)

 

• Support the development and implementation of strategies to drive CAHPS performance improvement.
• Coordinate the planning and execution of member and provider initiatives and campaigns for the Medicare STAR program. This may include material development, outbound campaigns (mail/phone/email), case review, and other cross-functional initiatives to improve member experience and satisfaction.
• Track and report on outcomes and KPIs for the program to ensure progress is met throughout the various project life cycles. Conduct quantitative and qualitative analysis of initiatives to assess effectiveness.
• Assist in tracking projects and actions using designated operating and project plans.
• Responsible for formulating and executing all processes, requests, workflows or policies as requested by management in an efficient manner, including offering a proactive approach to suggestions and recommendations.
• Responsible for collecting data from various sources, such as EMR systems, the enterprise data warehouse (EDW), command center, and other internal and external data sources.
• Use critical thinking skills to solve a wide array of problems and use a solutions-based approach when presenting issues.
• Implement process improvements to streamline departmental functions.
• Preparation of meeting materials or training documentation as needed.
• Ensure patient privacy is protected by adhering to HIPAA standards, company policies and procedures, and other federal, state, and local requirements.

Supervisory Responsibilities:

There are no supervisory responsibilities.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Minimum Experience:
   • Minimum 1-2 years of quality improvement, CAHPS, and/or Medicare STAR program experience required in a health plan, managed care, or medical group/IPA setting.
   • Experience with improvement activities and tactics to influence member/patient perception and satisfaction.
2. Education/Licensure:
   • Bachelor’s degree (BA or BS) from four-year college or university is required. Health-related field (Health Science, Health Administration, or related) is preferred.
3. Other:

• Proficient in Microsoft Office (Outlook, Excel, Work, PowerPoint required. Visio and Access are preferred) and familiar working with large data sets.
• Knowledge of medical terminology and HIPAA.
• Mathematical skills, attention to detail, problem-solving and analytical skills are essential.
• Self-starter; able to work independently with minimal supervision.
• Strong communications skills: written, verbal, and interpersonal
1. Work Environment:
• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Quality Improvement Specialist

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].