Quality Specialist (Hybrid)

Resp & Qualifications

PURPOSE:

Utilizing the population health frameworks provided by NCQA Accreditation, HEDIS and CMS, this position is responsible for delivering culturally appropriate health promotion information to members that helps increase their access & reduce their barriers to preventive care resulting in industry-leading outcomes at a population level. Uses expertise in HEDIS and other technical quality measures and advanced member engagement techniques to ensure improved population health and accreditation results.

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

ESSENTIAL FUNCTIONS:

• Conducts member and provider outreach designed to close member gaps in care, documenting such efforts in a manner that allows collaboration with other team members and other member-facing care delivery staff.
• Analyzes quality reports and claims data to assess up-to-the-minute member compliance status to a wide variety of quality measures, utilizing this information to improve compliance and member health outcomes.
• Collaborates with a variety of in-home & community-based providers to locate non-compliant members, managing member referrals to those providers for a variety of gap-closing quality campaigns. Maintains access to provider reporting of gap-closure outcomes and facilitates the transmission of such information as supplemental data where allowed.
• Maintains ongoing subject matter expertise in population health, measurement science, accreditation, and quality improvement. Utilizes the framework of NCQA Accreditation, HEDIS & CMS quality standards to accomplish and document the work products.

QUALIFICATIONS:

Education Level: Bachelor''s Degree in Population Health, Public Health, Healthcare Administration, Business Administration, Health Policy, Economics, Statistics, Mathematics, Data Science, or a related field OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.

Preferred Qualifications:

• Previous experience in member and provider engagement to influence behavior change and improved health outcomes.
• Certification in Quality or Process Improvement Methods.
• Direct experience with accreditation, HEDIS, CAHPS and other quality related activities a healthcare related environment and/or payor organization.

Knowledge, Skills and Abilities (KSAs)

• Ability to engage health care consumers and/or health care providers in outcomes driven assessment, planning and execution of improvement activities.
• Expertise in qualitative and quantitative data analyses and presentations.
• End-to-end experience designing, developing, and implementing innovative strategies to improve population health.
• Fluent in the use of Microsoft tools including Excel, Word, Power Point and Outlook.
• Knowledge of healthcare claims, survey, clinical, and health data.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $48,168 - $95,667

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate''s work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case''s facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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