Healthcare Quality Management Consultant

Our goal is to solve problems and deliver results for our clients. At Cloud and Things, you can be a part of transforming the public sector's IT environment. Our team is on the forefront of helping to solve the government's most complex IT challenges. If you are seeking a role that offers the opportunity to work on rewarding projects, consider a career with Cloud and Things.

Overview:

We are seeking a Healthcare Quality Management Consultant who will support our client. The Healthcare Quality Management Consultant will analyze healthcare data, including patient demographics, claims, and prescriptions, to generate business intelligence insights. They will ensure compliance with healthcare data standards (HIPAA, HL7, ICD-10, etc.) and collaborate with leadership to improve healthcare processes and system performance.

Duties:

• Analyze and interpret healthcare data, including patient demographics, provider rosters, program enrollment, claims, prescriptions, and laboratory results.

• Ensure compliance with healthcare data standards such as HL7, HIPAA, and NCPDP while utilizing relevant code sets like LOINC, SNOMED, and ICD-10.

• Oversee the design, procurement, implementation, and maintenance of healthcare technologies to improve business processes.

• Lead infrastructure and programmatic implementations that enhance healthcare system performance.

• Develop and implement performance improvement initiatives in collaboration with executive leadership.

• Design healthcare quality, efficiency, access, and outcome measures based on nationally recognized standards.

• Provide strategic consultation to healthcare organizations to align performance measurement with organizational goals.

• Drive transformative business process improvements within large healthcare organizations.

• Support enterprise technology deployments and identify opportunities for IT enhancements.

Mandatory Qualifications:

• 5 years' experience in working with data on patient demographics, provider rosters, program enrollment, third party claims, prescriptions, and laboratory results to produce complex analyses and business intelligence products.

• 5 years' experience in working with healthcare data standards (e.g., Health Level Seven International (HL7), Health Insurance Portability Accountability Act (HIPAA), National Council for Prescription Drug Programs (NCPDP) and code sets (e.g., Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine (SNOMED), International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10), General Code Number (GCN), National Drug Code (NDC).

• 3 years' experience in design, procurement, implementation, training, maintenance, and upgrades for technologies that were adopted by healthcare staff to support and improve healthcare business processes.

• 3 years' experience in overseeing infrastructure and/or programmatic implementations that improved health business processes and overall health system performance.

• 3 years' experience in designing healthcare quality, efficiency, access, process, enrollment, satisfaction, and outcome measures based on nationally recognized standards (e.g., National Committee for Quality Assurance (NCQA), Agency for Healthcare Research and Quality (AHRQ), National Quality Forum (NQF), The Joint Commission (TJC).

• 3 years' experience overseeing multiple concurrent performance improvement initiatives for large public healthcare agencies.

• 3 years' experience working with the executive leadership of healthcare organizations to design and manage the strategies, goals, objectives, and actions that define core performance management activities, such as identifying specific information needed to clarify a situation or make a decision, defining benchmarks that allow comparisons where similar data is collected, proposing new approaches, methods, or technologies, aligning performance measurement with organization strategic goals, and providing consultative services that add interpretive value to performance metrics.

• 5 years' experience working with large healthcare organizations to implement transformative business process improvements throughout an entire operation.

Preferred Qualifications:

• Possession of a Master's in Business Administration (MBA).

• Possession of a valid Project Management Professional (PMP) certification from the Project Management Institute (PMI) (valid dates must be verifiable).

• 5 years' experience deploying enterprise technology solutions within a healthcare and/or correctional environment.

• 5 years' experience translating healthcare related business requirements into technical solution capabilities.

• 5 years' experience evaluating current information technology applications and identify improvement opportunities (e.g., electronic health record systems, offender management systems, scheduling systems, Power BI).

• 2 years' experience with correctional healthcare operations.

• 2 years' experience and familiarity with Quality Management solutions and business requirements in a correctional healthcare setting.

Cloud and Things complies with all applicable federal, state, and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other category protected by applicable federal, state, or local laws.