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Quality Coordinator
Kapolei, HI
Job Description
- Serves as NCQA subject matter expert, ensures health plan compliance and support as it relates to department programs and activities.
- Initiate, facilitate and coordinate quality improvement activities and metrics to support assigned NCQA standards and requirements.
- Proactively keep all staff updated on NCQA standards and application, through notifications of change, workflow and documentation updates, and training.
- Analyze, promote, and implement updates to department operations to effectively support health plan accreditation.
- Conduct quality monitoring and auditing of system documentation to include member records.
- Partner with Quality Management team to support health plan NCQA accreditation.
- Complies with timelines and deadlines.
- Create, revise, and maintain all supporting documentation, including program descriptions, reports, work instructions, workflows and policies.
- Provides quality update at Quality Improvement committees to include Case Management Committee.
- Support staff training with the assistance of department trainer.
- Performs case management delegation oversight activities of providers in collaboration with Delegation & Quality Coordinator.
- Member satisfaction survey administrator.
- Oversee administration of department member satisfaction surveys for multiple clinical programs by ensuring survey workflow consistently continues, barriers are removed, and deadlines are met.
- Facilitate print/mail workflow with administrative and IT services.
- Validate data and process flow.
- Prepare file for mail merge by administrative support team.
- Maintain master data collection file.
- Quality assurance monitoring through system documentation.
- Prepare monthly report to managers.
- Share member feedback with staff.
- Research negative comments and low scored responses.
- Partner with Corporate Analytics for data analysis.
- Support staff training with the assistance of department trainer.
- Identify opportunities for improvement, facilitate & implement interventions.
- Reporting, Data, and Analytics
- Prepares reports and presentations to educate and communicate information and results related to metrics, requirements, operation & audit trends, project and quality improvement activities. Duties include, but are not limited to:
- Program evaluations
- Outcome summaries
- Identifies, coordinates and participates in quality monitoring and improvement opportunities to improve program performance, facilitate change, and take action to implement ideas.
- Takes initiative to research issues, conduct root cause analysis, documents
- Prepares reports and presentations to educate and communicate information and results related to metrics, requirements, operation & audit trends, project and quality improvement activities. Duties include, but are not limited to:
- Program Operations
- Targeted member communications: Identify target population and develop & maintain communication material for initiative and program communication via mailing and alternative communication channels.
- Create, update, and maintain: Program descriptions, Policies & procedures, workflows, work instructions, reference documents and, operational manuals.
- Oversee maintenance and accuracy of online material related to department programs.
- Delegation
- Serves as additional support and back-up to delegation point and activities such as:
- Host & facilitate meetings with provider organizations.
- Chart audit activities
- Program evaluations
- General program support such as material/correspondence reviews, billing/invoice workflow, report development & presentations.
- Serves as additional support and back-up to delegation point and activities such as:
- Performs all other miscellaneous responsibilities and duties as assigned or directed.
- Assists with special projects and department priorities/initiatives.
- Support staff & operations to ensure daily operations continue.
#LI-Hybrid
Job Summary
Company
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
Open
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