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Clinical - Exception Template

Mindlance

Remote, OR(remote)

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JOB DETAILS
SKILLS
Analysis Skills, Business Administration, Business Growth, Business Strategy, Clinical Competency, Clinical Medicine, Data Analysis, Data Collection, Diversity, Health Insurance, Health Plan, Healthcare, Healthcare Administration, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Management, Healthcare Quality, Hospital/Healthcare Construction, Identify Issues, Informatics, Lean Manufacturing, Lean Six Sigma, Licensed Clinical Social Worker (LCSW), Licensed Practical Nurse/Licensed Vocational Nurse, Logistics, Managed Care, Metrics, Nursing, Operational Audit, Operational Measurement, Organizational Skills, Outbound Marketing, Performance Management, Performance Metrics, Power BI, Problem Solving Skills, Process Development, Process Improvement, Project Evaluation, Project Management Certification, Project Management Professional (PMP), Project Tracking, Project/Program Management, Public Health, Quality Assurance, Quality Management, Quality Metrics, Quality Monitoring, Registered Nurse (RN), Regulations, Reporting Dashboards, Requirements Management, Risk Analysis, SQL (Structured Query Language), Scorecarding, Six Sigma Black Belt, Six Sigma Certification, Six Sigma Green Belt, Testing, Time Management
LOCATION
Remote, OR(remote)
POSTED
1 day ago
112021-Quality Program Strategist "Position Purpose:
Plans, organizes, and monitors quality related projects to deliver defined requirements and meet company strategic objectives.



Education/Experience:
Associate s degree in Nursing, Public Health, or related clinical field, or equivalent experience. 2+ years clinical experience or managed care.health insurance experience required; 1+ year quality experience preferred.

License/Certification:
Registered Nurse, Licensed Practical Nurse, Licensed Vocational Nurse or Licensed Clinical Social Worker preferred; CPHQ preferred"
"Support enterprise-wide quality initiatives by analyzing and researching potential issues within quality metrics and goals of health plan programs, including the determination of the appropriate target population, health program design, marketing of the program, and data systems; recommend quality improvements to achieve goals, including updates to programs and processes

Create quality risk assessments and develop processes for health plans to achieve quality metrics

Utilize Lean 6 Sigma methodologies to identify potential problems and resolutions with enterprise-wide priority metrics

Collaborate through ad hoc initiative requests and scorecard review and to support initiative development and implementation

Create, maintain and facilitate quality improvement health plan training Performs other duties as assigned

Complies with all policies and standards"

EEO:

Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.

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Story Behind the Need
  • What is the purpose of this team?
  • What is driving this need? (ex. Backfill for FTE or CW, new project, business growth)
  • Describe the surrounding team (team culture, work environment, etc.) & key projects.
  • Do you have any additional upcoming hiring needs, or is this request part of a larger hiring initiative?
  • Need 1 additional FTE, a Quality Program Strategist, to support Oregon performance measure operations.
  • The Increase in membership, measure scope, and reporting requirements will begin to impact staffing July 2026.
  • The productivity analysis shows a conservative anticipated total annual workload of 2.13 FTEs, while current staffing for this scope is 1 FTE.
  • This person would be working with HEDIS and other state measure workstreams, program management, dashboarding, process improvement, and measure validation. We re looking for someone with knowledge and experience with Excel, SQL, and PowerBI (or similar). Please note that this role does not require a clinical license.
  • The HEDIS Ops team is comprised of Quality Improvement Specialists, Quality Analysts, and a HEDIS Coordinator. We are 100% remote but stay connected through Teams and huddles.
  • No, this is currently the only FTE needed.


Typical Day in the Role
  • Walk me through the day-to-day responsibilities and a description of the project (Outside of the Workday JD).
  • What are performance expectations/metrics?
  • What makes this role unique?
 Responsibilities:
  • Support enterprise-wide quality initiatives by analyzing and researching potential issues within quality metrics and goals of health plan programs, including the determination of the appropriate target population, health program design, marketing of the program, and data systems; recommend quality improvements to achieve goals, including updates to programs and processes
  • Create quality risk assessments and develop processes for health plans to achieve quality metrics
  • Utilize Lean 6 Sigma methodologies to identify potential problems and resolutions with enterprise-wide priority metrics
  • Collaborate through ad hoc initiative requests and scorecard review and to support initiative development and implementation
  • Create, maintain and facilitate quality improvement health plan training
  • Performs other duties as assigned
  • Complies with all policies and standards

Performance Expectations:
  • provide data logistics/infrastructure to help data-driven decisions, such as compiling data and performance dashboards
  • Support team through regulatory deadlines and corporate deliverables

What makes this role unique:
  • This role is a unique blend of healthcare quality analytics, program management, and process improvement. You ll partner with Operations, Analytics, and Provider teams within the Quality department to improve performance on state and federal quality metrics and other regulatory programs. Your work will directly influence member outcomes and organizational performance.
  • This is a great opportunity for someone who wants to make a meaningful impact while building expertise in healthcare analytics. The role is well suited for an individual who enjoys solving complex problems, working with data, and seeing their efforts drive measurable results across the organization.
Candidate Requirements
Education/Certification Required:
Bachelor s degree in:
  • Public Health,
  • Health Administration/Healthcare Management,
  • Business Administration,
  • or equivalent 5+ Year experience in Health insurance
 Preferred:
  • Master s degree (MPH, MHA, MBA).
  • 1+ year quality experience preferred
Licensure Required: None Preferred: CPHQ, Healthcare Data Analytics or Informatics certifications, Lean Six Sigma (Green Belt or Black Belt), Project Management certifications (PMP, CAPM)
Years of experience required: 2+ years clinical experience or managed care. 1+ year quality experience preferred

Disqualifiers: no experience with data/technology

Additional qualities to look for: knowledge and experience with Excel, SQL, and PowerBI (or similar).
  • Top 3 must-have hard skills stack-ranked by importance
 1 Advance Excel skills (formulas, dashboards)
2 Project Management
3 PowerBI (data modeling, visuals)
Candidate Review & Selection
  • Shortlisting process
  • Candidate review & selection
  • Interview information
  • Onboard process and expectations
 Projected Manager Candidate Review Date: 1-2 days post shortlisting

Type of Interviews:
 Teams video interviews
Required Testing or Assessment (by Vendor): Excel proficiency test, basic project management evaluation- Advanced/Expert level
Next Steps

About the Company

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Mindlance

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