Meridian of Illinois · 22 hours ago
Quality Program Strategist II
Illinois, United States
Full-time
Remote
Mid Level
$67K/yr - $121K/yr
4+ years exp
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Responsibilities
Identify market trends and oversee functions of quality improvement programs for HEDIS, CAHPS, and/or HOS strategy and related quality improvement activities.
Assists stakeholders to determine their business issues and recommend solutions to drive business value.
Analyze stakeholder business issues, formulate hypotheses and test conclusions to determine appropriate solutions.
Conduct evaluations to assist with HEDIS gap closure, CAHPS and/or HOS performance and assess for potential pilot programs and/or process improvements to achieve sustainable quality performance goals.
The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools.
Leverage data analysis to derive actionable insights and strategic recommendations for performance improvements.
Collaborate and provide support to markets & key business stakeholders to drive continued measure performance.
Develop HEDIS, CAHPS, and/or HOS support resources and tools to foster gap closure & improve experience for members and providers.
Conduct ongoing assessment to determine health plan needs, collaborating with cross-functional teams to ensure successful end to end execution of strategic initiatives.
Monitor and ensure compliance related to state reporting, HHS and HPMS memos for quality ratings.
Establish quality check policy/procedures for all member and provider communications to ensure accuracy of information, data, and alignment with Centene business goals.
Establish QPS policies, procedures, and quality checks for all reoccurring departmental programs/activities, to ensure precision execution and accuracy.
Create, maintain and facilitate training for Quality Improvement Health Plan staff as applicable to assigned responsibility.
Performs other duties as assigned
Complies with all policies and standards.
Qualification
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Required
Bachelor’s degree in Nursing, Public Health, related field, or equivalent experience
4+ years of clinical experience, managed care or health insurance experience
Experience improving Medicare Advantage (MA), Dual CMS Stars Quality and Member Experience measures to an overall 4 star or above
Intermediate proficiency with analytical tools (e.g., Excel)
Ability to create and maintain key presentations
Proficient use of Quality Improvement tools (e.g., Root Cause Analysis)
Experience with CMS MA and DSNP technical specifications
Solid understanding of CMS MA Star and DSNP ratings and strategies to improve performance
Preferred
Master’s degree
2+ years of quality experience
Registered Nurse (RN), Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker (LCSW)
CPHQ
Benefits
Health insurance
401K
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
Meridian of Illinois
As a Medicaid MCO, Meridian of Illinois provides healthcare to beneficiaries enrolled in the Family Health Plan and Integrated Care Program through a contract with the Illinois Department of Healthcare and Family Services.
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
Daniel Rich
Plan Chief Operating Officer
Company data provided by crunchbase
