Territory Management Consultant
EMC Insurance Companies
Clinical Quality Consultant, Medicare
Cambia Health Solutions
full-time
Posted on:
Location: Idaho, Oregon, Utah, Washington • 🇺🇸 United States
Visit company websiteSalary
💰 $120,000 - $125,000 per year
Job Level
SeniorLead
Tech Stack
SaltStack
About the role
- Develops and maintains required quality program documents, including standardized quality management plans to ensure regulatory and accreditation compliance.
- Serves as point of contact coordinating with accreditation entities and business partners for compliance with accreditation and/or performance measurement requirements.
- Prepares the enterprise for accreditation and/or performance measurement submissions and reviews.
- Acts as subject matter expert for applicable accreditation standards and measurement requirements.
- Recommends improvements or remediation to business units for accreditation/reporting compliance and improvement programs.
- Monitors accreditation/measurement risks and identifies mitigation opportunities.
- Compiles information for internal use and external audits and maintains relevant records.
- Assists with development and maintenance of required quality program documents and reporting to quality committee and management.
- Manages and coordinates quality committees, including scheduling, workflows, minutes and reporting.
- Works with clinical and operational areas to develop performance metrics and tracking systems for health quality improvement.
- Identifies areas for improvement and implements interventions or corrective action plans.
- Keeps leaders informed through regular written and verbal project status communications.
- Handles complex quality initiatives and provides training to new team members and colleagues across the organization.
- Work from home (telecommute) within Oregon, Washington, Idaho or Utah; multiple office locations listed (e.g., Portland, OR; Salt Lake City, UT).
Requirements
- Preferred: Clinical Experience (RN/BSN).
- Knowledge/experience with Medicare STARS and HEDIS.
- Bachelor’s degree in business administration or related field (or equivalent combination of education and experience).
- 8 years of progressive experience in health care administration, quality, project leadership or project support (96 months minimum).
- Demonstrated knowledge of quality improvement processes and performance measurement.
- Ability to identify problems, develop solutions and implement actions.
- Leadership skills to direct activities of others and coordinate project teams.
- Ability to organize, plan, prioritize and manage multiple projects under time constraints.
- Strong knowledge of data integrity/validity standards and basic quantitative/qualitative analysis skills.
- Knowledge of the healthcare industry, preferably managed care.
- Excellent verbal and written communication skills across multiple areas and levels.
- Participation in NCQA/URAC accreditation process and/or full HEDIS production reporting, audit and medical record collection preferred.
- Background check required; employer is an Equal Opportunity employer and maintains a drug and tobacco-free workplace.
