Cambia Health Solutions

Clinical Quality Consultant, Medicare

Cambia Health Solutions

full-time

Posted on:

Origin:  • 🇺🇸 United States • Idaho, Oregon, Utah, Washington

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Salary

💰 $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.