What are the responsibilities and job description for the Quality Improvement Specialist Senior position at Sunflower Health Plan?
Transforming the Health of Communities, One Person at a Time
Position Purpose:
The Senior Quality Improvement Specialist is responsible for coordinating assigned regulatory, accreditation, clinical quality and/or service improvement programs. This role serves as a leader for assigned health services initiatives, handling multiple large-scale complex initiatives.
- Leads and manages multiple complex initiatives that impact the quality or effectiveness of healthcare delivery and/or healthcare services provided to members.
- Ensures that clinical and service quality improvement programs and initiatives are compliant with applicable accreditation, state, and federal requirements.
- Conducts an assessment of programs, initiatives, and interventions to ensure goals and objectives were met and refines activities, as needed, to improve the effectiveness and outcomes.
- Manages vendor oversight and ensures compliance.
- Develops targeted activities to improve Star Ratings, HEDIS, CAHPS, HOS, provider satisfaction, and other identified performance measures.
- Develops and implements project-related communication, including member/physician mailings, IVR scripts, emails, business plans, graphics, and maintains minutes and agendas.
- Participates in the development and maintenance of annual quality improvement program documents and evaluations, compliance audits, policies, and procedures.
- Develops internal reports to demonstrate progress on each initiative/project and presents to senior-level staff.
- Describes outreach initiatives, potential/experienced barriers, and activities to resolve issues and improve outcomes.
- Leads and/or participates in multi-department/cross-functional committees and work groups supporting key initiatives, prepares reports, data, agendas/minutes, or other materials for committee presentation and management.
- Identifies areas of improvement within the organization and works collaboratively with other departments to develop clinical and non-clinical performance improvement projects.
- Researches best practices, national and regional benchmarks, and industry standards.
- Develops collaborative relationships with contracted providers or provider groups to promote participation in quality improvement collaboratives to improve clinical care outcomes.
- Maintains current knowledge of industry trends and regulations for enterprise-wide adoption to assure quality and effectiveness of healthcare delivery and/or healthcare services provided to members.
Education/Experience:
A Bachelor's Degree or equivalent experience with a clinical license or Master's Degree in a related health field (i.e., MPH or MPA) is required. A valid state clinical license is preferred, and certification as a Certified Professional in Healthcare Quality (CPHQ) is also preferred.
Three to five years of managed care experience in a healthcare environment, with experience in compliance, accreditation, service, or quality improvement, is required. Complex project management experience is also required. Experience with Medicare and/or NCQA is preferred.