University of Utah Health Care

Returning Candidate?

Health Plans Quality Improvement Specialist

Health Plans Quality Improvement Specialist

Requisition Number 
27544
Reg/Temp 
Regular
Employment Type 
Full-Time
Shift 
Day
Work Schedule 
8-5
Location Name 
University of Utah Health Plans
Patient Care? 
No
City 
Murray
State 
UT
Department 
UIP CST 01H UUHP ADMIN
Category 
Insurance / Health Plans

More information about this job

Overview

As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission. EO/AA

This position for use in Health Plans Departments only.

This position reports to the University of Utah Health Plans (Health Plans) Quality Improvement Manager and is responsible for quality improvement program design, data collection, analysis and presentation related to our Medicaid, commercial, and Medicare products. The position works closely with University and non-University hospitals and clinics, physicians, the Utah Medicaid program, and multiple community partners.

Responsibilities

  • Act as a facilitator and consultant for Health Plans quality improvement initiatives, providing expert input regarding problem identification and resolution, continuous quality improvement, process mapping and redesign, and regulatory requirements.
  • Partner with leadership, providers and staff to design and implement strategies for identified quality improvement opportunities.
  • Facilitate communication and collaboration across providers and the continuum. Collaborate with leaders, departments, committees, and individuals to support the Health Plans mission and strategic goals.
  • Perform audits, chart review, and prepares reports to assess and improve Health Plan compliance with HEDIS measures, operational goals, State Medicaid, and CMS requirements.
  • Review and interpret patient care information, from the medical record and other data sources used to identify quality of care issues, transforms these facts into actionable information for improvement work.
  • Provides education to the organization regarding quality and patient safety topics, performance improvement, and other regulatory metrics and standards.
  • Use data to facilitate change, to develop goals, and determine progress toward relevant evidence-based benchmarks. Review and interpret claims and medical record data, and population management analytics, to develop actionable information to facilitate improvement. Collaborate with the care management team on program design and outcome monitoring.
  • Provide technical assistance to providers in quality assessment, monitoring, and improvement. Develop collaborative projects and work with care management teams, a variety of public and private providers, policymakers, and researchers to facilitate improvement in population health.
  • Lead staff in identifying, prioritizing, and developing action plans to respond to emerging population and service needs. Lead and/or participate in performance improvement initiatives to identify quality and regulatory trends and plan improvement work.
  • Perform internal audits and prepares reports to assess and improve organizational compliance with new or existing quality metrics, standards, operational goals, and/or improvement initiatives.

Knowledge / Skills / Abilities

  • Ability to perform the essential functions of the job as outlined above.
  • Strong Knowledge of health care quality improvement principles and methods.
  • Knowledge of Microsoft Office applications and Epic.
  • Knowledge of insurance and managed care operations.
  • Knowledge of ICD-9/ICD-10, CPT, HCPC, DRG, Revenue codes, insurance, and managed care principles.
  • Data analysis and data presentation skills; ability to identify trends and opportunities for improvement.
  • Developing and giving effective presentations to diverse groups.
  • Strong leadership, quality improvement, and team facilitation skills.
  • Excellent written and verbal communication.
  • Ability to adapt to organizational and program changes sufficient to work constructively and to cope with ambiguity and setbacks.
  • Excellent human relations and communications skills.
  • Demonstrated analytical skill and attention to detail.
  • Able to work independently and as part of a highly collaborative team with a minimum of supervision.
  • Ability to manage projects, multiple priorities, and meet deadlines.
  • Active listening, speaking, critical thinking, service orientation, judgment, and decision making skills.
  • Demonstrated leadership skills in planning and directing process improvement initiatives, to ensure the smooth operation of the department.

Qualifications

Qualifications

Required

  • Bachelor’s degree in a health care field or equivalency.
  • Three years clinical or other health care experience.
  • Obtain CPHQ certification within two years of employment.

Qualifications (Preferred)

Preferred

  • CPHQ certification.
  • Master’s degree in a healthcare or related field.
  • Three years leading and/or facilitating quality improvement activities in a health care setting.
  • Training in Project Management, Lean, Six Sigma, Performance Improvement, Facilitation, Human Factors, Process Mapping.
  • HEDIS

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

  • This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move object. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements

Carrying, Far Vision, Listening, Near Vision, Sitting, Speaking, Standing, Walking