[Hiring] Quality Improvement Professional @CenterWell

Role Description

The Stars Quality Improvement Professional will support clinicians and staff, working collaboratively with the staffed clinical and operations teams including center administrators. You will provide support, make recommendations and help implement quality improvement best practice programs designed to improve CMS Star measures (HEDIS), patient safety and patient experience (CAHPS-HOS). Your assignment may be coverage of PCO staffed providers and PCO Independent Network provider/practices functioning in a similar capacity as described previously for support to the staffed centers. Best suited candidate will have an interest and practical experience working with clinical Star measures in particular medication adherence and HEDIS. You will report to the Associate Director, Quality Improvement.

• Use approved avenues to outreach to patients with medication reminders.
• Medical record review, retrieval, and submissions to health plans to support HEDIS gap closure.
• Distribute time-sensitive data to promote action on the part of clinical teams and operations to address opportunities and close gaps (excel moderate-to-advanced skills).
• Review and assess provider/member detail HEDIS data/gap reports to identify opportunities for improvement and gap closure.
• Lead efforts to identify opportunities for improvement, workflow deficiencies and barriers.
• Develop and implement strategies to achieve annual Stars goals within market and centers.
• Provide support to provider/practice specific needs thus helping guide the implementation of the quality improvement strategy.
• Manage workloads such as the distribution of medication adherence reports to PCP.
• Train/educate teams on CMS Star measures, one-on-one or in a setting with multiple team members (clinicians, medical assistants, practice administrators, front office).
• Present Stars performance information during meetings one-on-one or in wider settings; create PowerPoint presentations.
• Collaborate with multiple partners to provide support and in some cases help implement workflows developed to improve outcomes for HEDIS, patient safety (such as medication adherence) and patient experience.
• Support quality project events such as eye screenings, bone mineral density, etc.

Qualifications

• Experience with healthcare STARS measures (HEDIS, Patient Safety, and Patient Experience (CAHPS/HOS) in particular knowledge of the measure technical specifications.
• 2+ years' experience working with CMS Stars measures.
• Prior experience in a healthcare setting direct hands-on patient care, front office or provider relations field.
• Experienced providing training 1:1 or in a group setting.
• Experience with Microsoft Office Suite.
• Must reside in the Houston area and be willing to travel locally.

Requirements

• Bachelor's Degree.
• Prior LPN/LVN, Lead Medical Assistant or Center Administrator experience.
• Knowledge of Humana's internal policies, procedures, and systems.

Benefits

• Competitive benefits that support whole-person well-being.
• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance and many other opportunities.

Company Description

CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes.

CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients.