What are the responsibilities and job description for the Quality Coordinator position at The Health Plan of West Virginia, Inc.?
Under the direction of the Director, Quality Improvement, is responsible for assisting with administering and monitoring plan-wide Quality Improvement & Quality Management initiatives and compliance related to NCQA Accreditation, CMS, BMS, and EQRO Compliance. Collaboratively works with the Director, Quality Improvement and other departments to implement opportunities for improvement based on barrier analyses.
Required :
Minimum 2-year degree in applied science, business, or other related field; or a minimum of 2 years experience in quality improvement / project management.
Excellent verbal and written communication skills.
Project management experience with the ability to plan, execute and complete long-term projects (minimum 2 years).
Advanced knowledge of Microsoft Office applications.
Strong public speaking and written communications skills.
People and team management skills.
Excellent interpersonal skills and the ability to build rapport with others.
Ability to work independently but also in a collaborative team setting.
Desired :
Managed Care experience.
CPHQ certification or other quality improvement driven distinctions.
Working knowledge of HEDIS and NCQA Health Plan Accreditation.
Responsibilities :
Assists in coordination of development strategies for NCQA Accreditation, CMS, BMS, and EQRO Compliance.
Assists with Quality Improvement & Quality Management projects and activities related to enhancing organizational compliance with NCQA, CMS, BMS, and EQRO.
Coordinates benchmarks with internal departments to identify strategies for improving care and service, and experience related to accreditation processes.
Works with applicable business owners for data reporting and data analyses required for NCQA and EQRO activities.
Assists to develop action plans for improving NCQA and EQRO compliance.
Performs mock audits related to NCQA and EQRO requirements.
Provides mock audit and file review findings to assist with the development of corrective action plans.
Collaborates with internal departments, delegated entities, and vendors to enhance compliance with NCQA and EQRO requirements.
In collaboration with THP stakeholders, assists to create and revise Quality Management documents, including program descriptions, policies and procedures, analytical reports, and materials, annually and as needed.
Assists to develop and present training materials to employees, providers and members on Quality Improvement & Quality Management initiatives including, NCQA / EQRO requirements and other quality improvement related initiatives.
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