Advertisement
 

Quality Improvement Specialist - Waipahu Job Details

back to search results

Vacancy has expired

Show me jobs like this one
Loading ...

Company:  WellCare Health Plans, Inc.
Job Code:  1000473
Categories:  For-Profit Senior Services
Job Role:  LPN / LVN / Nurse
Region/Province:  Hawaii (HA)
City:  HI-Oahu-Honolulu
Job Description:  !*!About WellCare: We provide managed care services targeted exclusively to government-sponsored health care programs, focused on Medicaid and Medicare, including prescription drug plans and health plans for families, and the aged, blind and disabled. As of March 31, 2009, we served nearly 2.5 million members. Our experience and our exclusive commitment to these programs enable us to serve our members and providers, and to manage our operations efficiently.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the Company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national PDP provider and the largest Medicaid plan in Georgia. Today WellCare has grown to be the eighth largest publicly traded health care plan in the country with 3,800 associates and nearly 2.5 million members nationwide.
Supports the development and implementation of quality improvement interventions and audits and assists in resolving deficiencies impacting plan compliance to regulatory and accreditation standards.  Interfaces with a diverse range of clinical and administrative professionals, resolves complex issues, and performs data analytic and reporting activities.

 


Essential Functions:



  • Manages and monitors quality improvement initiatives including, but not limited to, development and implementation of preventive health and chronic disease outcome improvement interventions such as:  newsletter articles, member education and outreach interventions, provider education, member outreach interventions, medical record reviews, focus groups, and surveys.

  • Analyzes, updates, and modifies procedures and processes to continually improve QI operations.

  • Collects and summarizes performance data, identify opportunities for improvement, and present findings to Quality Improvement Committees.

  • Leads and facilitates quality improvement teams in the development of QIPs, PIPs and QIAs

  • Serves as knowledge expert for continuous quality improvement activities.

  • Monitors and analyzes outcomes to ensure goals, objectives, outcomes, accreditation and regulatory requirements are met.

  • Participates in site visit preparation and execution by regulatory and accreditation agencies (State agencies, CMS, AAAHC, URAC, NCQA,EQRO).

  • Conducts internal auditing of compliance with regulatory and accreditation standards.

  • Supports the implementation of the quality reporting infrastructure.

  • Pursues methods to ensure receipt of data required for trending and reporting of various QI work plan metrics, performs adequate data/barrier analysis, develops improvement recommendations, and deploys actions as approved.

  • Assists in activities to prioritize clinical and service improvement initiatives.

  • Participates in various QI committees and work groups convened to improve process and/or health outcomes, and contributes meaningful detail, based on functional knowledge.  Completes follow-up as assigned.

  • Manages and monitors assigned quality studies.

  • Investigates and incorporates national best practice interventions to effect greater rate increases.

  • Ensures that documentation produced and/or processed complies with state regulations and/or accrediting body requirements.

  • Ensures assigned contract/regulatory report content is accurate and that submission adheres to deadline.

  • Performs other duties as assigned.

Education:  A Bachelor's Degree in Healthcare, Nursing, Health Administration or related health field.  Master's Degree in Healthcare preferred.                                        

 

Experience:  2 years clinical experience with clinical degree program. 3-5 years managed care experience. Experience in compliance, accreditation, service or quality improvement.  Knowledge of accreditation, federal and state regulations/requirements

 

Licenses/Certifications:  Licensed Registered Nurse     

 

Special Skills (e.g. 2nd language): 

Excellent communication skills required

Ability to communicate effectively with people with varying levels of education

Ability to multitask in a fast paced environment

 

Technical Skills/Requirements:  Proficient in Microsoft Office such as Excel, Access, PowerPoint and Outlook 
Post Date:  08/23/2010
 

Featured Jobs